Epiglottitis

Diagnosis

The first step in diagnosing epiglottitis is ensuring that the airway is open and that the person is receiving enough oxygen. Breathing and blood oxygen levels are closely monitored. If oxygen levels drop too low, breathing assistance may be required.

Tests after breathing is stable include:

• Throat exam: Using a flexible fiber-optic lighted tube, a healthcare provider examines the throat through the nose to identify the cause of symptoms. A numbing medicine may be applied to the nose for comfort. This procedure might be performed in an operating room to ensure quick access to emergency care if the airway becomes blocked.

• Chest or neck X-ray: Although not essential for diagnosis, X-rays may help confirm epiglottitis. A characteristic “thumbprint” shadow in the neck area may indicate an enlarged epiglottis.

• Throat culture and blood tests: After stabilizing breathing, a sample from the epiglottis is collected with a cotton swab to test for Haemophilus influenzae type b (Hib). Blood cultures help detect bacteremia, an infection in the bloodstream often associated with epiglottitis.

Treatment

Treatment for epiglottitis focuses on securing the airway and controlling the underlying infection. Immediate medical attention is required to prevent life-threatening complications.

Helping with breathing
Maintaining proper airflow is the first priority. Breathing support methods may include:

• Wearing an oxygen mask to deliver oxygen directly to the lungs

• Inserting a breathing tube through the nose or mouth into the windpipe (intubation), which remains in place until throat swelling reduces — this may take several days

• In rare emergencies, performing a needle cricothyroidotomy, where a healthcare provider inserts a needle through the tracheal cartilage to quickly create an airway

Treating infection
Once breathing is stabilized, antibiotics are administered to treat the infection.

• Broad-spectrum antibiotic: Treatment typically begins immediately with a broad-spectrum antibiotic before test results are available.

• More-targeted antibiotic: Once culture results identify the exact bacteria causing the infection, the medication may be adjusted for a more precise and effective treatment.

With prompt diagnosis and treatment, most people recover fully from epiglottitis, though hospitalization and careful monitoring are usually required.