Epiglottitis is a serious and potentially life-threatening condition in which the epiglottis – a small flap of tissue that covers the windpipe during swallowing – becomes swollen and inflamed. This swelling can quickly block the airway, making it difficult to breathe. Because of this risk, the condition requires rapid diagnosis and emergency treatment to prevent respiratory failure.
Epiglottitis often develops suddenly and can worsen within hours. Common symptoms include a very sore throat, pain when swallowing, and trouble breathing. Affected individuals may make a high-pitched sound when breathing in (called stridor), have a muffled or hoarse voice, drool because swallowing is painful, and develop a fever. In severe cases, the skin may appear pale or bluish (cyanosis) due to low oxygen levels.
In the past, the main cause of epiglottitis was infection with Haemophilus influenzae type b (Hib), especially in children. However, since the introduction of the Hib vaccine, cases caused by this bacterium have become much less common. Other bacteria, such as Streptococcus pneumoniae and Staphylococcus aureus, can also lead to the condition. Viral and fungal agents can also cause epiglottitis, though less frequently.
Treatment focuses first on keeping the airway open. Doctors may need to provide breathing support, followed by antibiotics to treat the infection. Prevention is most effective through routine childhood vaccination with the Hib vaccine, which has greatly reduced the number of cases worldwide.
Epidemiology and Prevalence
The epidemiology of epiglottitis has changed considerably over the past several decades, primarily due to the introduction and widespread use of the Haemophilus influenzae type b (Hib) conjugate vaccine. Prior to vaccination programs, epiglottitis was most common in young children under the age of five and was considered a leading cause of acute upper airway obstruction in pediatric populations. With routine immunization, the incidence in this age group has declined dramatically in developed countries, transforming the disease from a predominantly pediatric emergency into one more frequently seen in adolescents and adults.
In developed regions such as North America, Europe, and Australia, Hib vaccination has reduced childhood epiglottitis cases by over 90%. For example, before the Hib vaccine era, annual incidence in children was estimated at 20–30 cases per 100,000. Today, in many vaccinated populations, the rate is less than 1 case per 100,000 children.
In developing countries, where Hib vaccination coverage is inconsistent, epiglottitis remains an important cause of morbidity and mortality in children. Limited surveillance data suggest higher prevalence in regions with inadequate healthcare access, incomplete vaccination schedules, and high rates of respiratory infections. Outbreaks still occur in areas where vaccination uptake is low or interrupted.
Some studies suggest that epiglottitis shows seasonal variation, with higher incidence during colder months. This may be related to increased circulation of respiratory pathogens during winter, higher rates of indoor crowding, and diminished mucosal immunity caused by cold air exposure.
Geographic differences are also evident. In Scandinavia and parts of Asia, for example, epiglottitis continues to be reported more frequently in adults, whereas in Africa and parts of South Asia, pediatric cases still occur regularly due to gaps in immunization.
Pathophysiology
The pathophysiology of epiglottitis centers on the inflammatory response of the supraglottic structures, especially the epiglottis, to infection or injury.
Initial Infection and Immune Response
The disease often begins with colonization and invasion by bacteria such as Haemophilus influenzae type b, Streptococcus pneumoniae, Staphylococcus aureus, or Group A Streptococcus. Viral infections (e.g., influenza, parainfluenza, herpes simplex) and, less commonly, non-infectious causes such as trauma or burns may also trigger inflammation.
Once the pathogen invades the mucosal lining of the epiglottis, the immune system mounts an acute inflammatory response. This includes:
- Vasodilation (widening of blood vessels), leading to increased blood flow.
- Capillary leakage and vascular permeability, allowing fluid and immune cells to infiltrate tissues.
- Edema (swelling) of the epiglottis and surrounding supraglottic structures.
- Erythema (redness) due to hyperemia and local vascular changes.
Airway Obstruction Mechanism
The epiglottis, normally a thin and flexible flap of cartilage, becomes thickened, rigid, and swollen during inflammation. This swelling progressively narrows the supraglottic airway, making it more difficult for air to pass during inspiration. Unlike other upper airway infections such as croup, which evolve over days, epiglottitis can obstruct the airway within hours, underscoring its medical urgency.
The narrowing causes stridor, a high-pitched sound during breathing, and increases the effort required to ventilate the lungs. As obstruction worsens, oxygen levels drop, leading to hypoxemia (low blood oxygen) and, if untreated, respiratory failure.
Systemic Effects and Complications
The infection is not confined to the epiglottis. If bacteria enter the bloodstream, patients may develop bacteremia or septicemia, spreading infection to distant organs. Severe inflammation may also lead to epiglottic abscesses or spread to adjacent deep neck spaces, complicating treatment.
The body’s systemic response, including fever and elevated inflammatory markers (like C-reactive protein and white blood cell count), reflects the severity of infection. In advanced cases, cyanosis (bluish discoloration of skin) and altered consciousness occur due to inadequate oxygen delivery to vital tissues.
Causes and Risk Factors
Epiglottitis develops due to a combination of infectious and non-infectious triggers. Certain populations are more vulnerable based on age, immune status, and pre-existing conditions.
Infectious Etiologies
The most common cause of epiglottitis is bacterial infection. Historically, Haemophilus influenzae type b (Hib) was the leading pathogen, especially in children under the age of five. Before the introduction of the Hib vaccine in the 1980s and 1990s, the majority of pediatric cases were linked to this bacterium. Widespread immunization has since led to a dramatic decline in Hib-related epiglottitis in many countries.
Today, other bacteria are more commonly associated with the condition. These include Streptococcus pneumoniae, a frequent cause of pneumonia and meningitis; Staphylococcus aureus, which can produce toxin-mediated infections; and Streptococcus pyogenes (group A Streptococcus), known for causing strep throat and invasive skin infections. Less commonly, epiglottitis may result from infections with gram-negative organisms such as Klebsiella pneumoniae.
Although far less frequent than bacterial cases, certain viruses have been implicated in epiglottitis. Influenza viruses, varicella-zoster (chickenpox virus), and herpes simplex virus have occasionally been reported as triggers. Fungal infections, such as Candida species, may also play a role, but almost exclusively in patients with weakened immune systems, such as those undergoing chemotherapy or organ transplantation.
Young children are particularly vulnerable to infectious causes due to the smaller diameter of their airways and an immature immune system, which makes even minor swelling more dangerous.
Non-Infectious Causes
While infections dominate, epiglottitis can also occur from non-infectious factors. Direct trauma to the throat such as injury from a sharp foreign object, burns from hot liquids or foods, or inhalation of caustic chemicals may lead to localized swelling of the epiglottis. Thermal injuries, especially in children who accidentally swallow hot substances, are a notable but preventable cause.
Severe allergic reactions, particularly those involving angioedema (sudden tissue swelling caused by histamine release), can also affect the epiglottis and nearby structures. This form of epiglottitis is rare but can progress rapidly, requiring emergency treatment similar to anaphylaxis.
Medical interventions themselves may occasionally provoke epiglottitis. Procedures such as endotracheal intubation, bronchoscopy, or other throat instrumentation can irritate or injure the epiglottis, leading to inflammation. In some cases, bacteria introduced during these procedures can precipitate infection. These iatrogenic (treatment-related) causes are more often documented in adults.
High-Risk Populations
Certain groups are more susceptible to developing epiglottitis due to biological, medical, or environmental factors.
- Children under five years old: This group remains particularly at risk, especially in regions where Hib vaccination coverage is low. Because their airways are narrower than those of adults, even minor swelling can cause severe obstruction.
- Unvaccinated individuals: Children or adults who have not received the Hib vaccine face a significantly higher risk of infection with Haemophilus influenzae type b.
- Immunocompromised individuals: People with weakened immune defenses, such as those living with diabetes, HIV/AIDS, cancer, or receiving immunosuppressive therapy, are more prone to severe infections, including epiglottitis.
- Adults with chronic conditions: Smokers, individuals with chronic obstructive pulmonary disease (COPD), and those with other respiratory illnesses may experience more severe inflammation when infected.
- Environmental and social factors: Close contact in crowded living situations, poor hygiene, and lack of access to routine healthcare can increase the spread of bacterial infections that may lead to epiglottitis.
Clinical Presentation
Epiglottitis typically presents with sudden onset of symptoms affecting breathing and swallowing. Early recognition of key signs is critical to prevent airway obstruction and related complications.
Major Symptoms
Patients often experience severe sore throat and difficulty swallowing (dysphagia), which worsens rapidly.Patients often describe the throat pain as disproportionate to the minimal or absent findings visible on routine throat examination. Swallowing typically becomes progressively painful, leading to drooling because saliva cannot be managed effectively.
Fever is almost always present and tends to be high-grade, often exceeding 38.5°C (101.3°F). The onset of fever and throat pain may initially resemble a viral sore throat or tonsillitis, but symptoms escalate far more rapidly in epiglottitis.
Respiratory distress is a defining feature as the illness progresses. Patients may develop stridor, a harsh, high-pitched sound heard during inspiration, reflecting narrowing of the upper airway. Stridor often worsens with agitation or exertion. Voice changes are common, with speech becoming muffled, hoarse, or described as a “hot potato voice” due to swelling in the throat.
In severe cases, patients experience tachypnea (abnormally rapid breathing), visible use of accessory muscles of respiration, and fatigue due to increased effort of breathing. Cyanosis, a bluish discoloration of the skin and lips, indicates dangerously low oxygen levels and impending respiratory failure if not corrected. Importantly, the progression of these symptoms typically occurs over hours, in contrast to other upper airway infections that evolve over several days.
Physical Examination Findings
On clinical examination, patients with epiglottitis often appear toxic, anxious, and restless, reflecting both the severity of the infection and the distress caused by breathing difficulties. Many assume a characteristic posture known as the “tripod position”—sitting upright, leaning forward, and extending the neck. This position maximizes airway diameter and improves airflow.
Direct examination of the throat is generally avoided outside a controlled setting because manipulating the airway may trigger complete obstruction. In most cases, the swollen epiglottis is not visible during routine inspection. Visualization often requires specialized equipment such as fiberoptic laryngoscopy, which must be performed with caution and in facilities equipped for immediate airway intervention.
Vital signs usually reveal fever, tachycardia (rapid heart rate), and tachypnea (rapid breathing). Clinicians may also observe suprasternal and intercostal retractions—visible inward pulling of the skin between the ribs and above the sternum—caused by increased effort to inhale through a narrowed airway. The voice is typically muffled, consistent with supraglottic obstruction.
Progression and Complications
Epiglottitis is distinguished by its potentially fulminant progression. Without treatment, swelling of the epiglottis and surrounding tissues can worsen within hours, leading to critical airway obstruction. In children, the small size of the upper airway means that even slight swelling can cause significant compromise, while in adults the progression may be somewhat slower but still dangerous.
Respiratory failure is the most feared complication, occurring when the airway becomes too narrow for adequate oxygen exchange. Patients may rapidly desaturate (drop in blood oxygen levels), leading to cyanosis, confusion, and loss of consciousness. Immediate airway management, such as intubation or surgical airway creation (tracheostomy), becomes necessary in such cases.
Secondary complications may also occur if the infection spreads. These include abscess formation in adjacent tissues such as the parapharyngeal or retropharyngeal spaces, and septicemia, a bloodstream infection that can cause systemic inflammatory response and organ dysfunction.
Diagnostic Evaluation
The diagnostic process for epiglottitis focuses on rapid identification of airway obstruction risk, confirmation of inflammation, and determination of causative factors. A thorough clinical examination is combined with targeted imaging and laboratory studies to ensure accurate diagnosis and guide management.
Initial Assessment
The first step in evaluation is always a rapid clinical assessment of airway stability. Any child or adult suspected of having epiglottitis must be considered at risk of sudden obstruction. Clinicians should immediately observe for hallmark signs such as inspiratory stridor, drooling, dysphagia, muffled speech, and the characteristic tripod positioning. The presence of severe agitation or cyanosis signals imminent airway compromise and requires urgent intervention.
Vital signs provide additional guidance: tachycardia, tachypnea, and fever are common, while oxygen saturation (SpO₂) is a critical parameter that must be continuously monitored. Arterial blood gas analysis, if obtainable without delaying care, may demonstrate hypoxemia or hypercapnia in advanced cases.
Importantly, routine oral or pharyngeal examination with a tongue depressor is contraindicated outside of an operating room or intensive care unit, as it may trigger complete obstruction. Instead, diagnosis relies heavily on clinical suspicion and careful adjunctive tests performed in controlled settings. Early involvement of anesthesiology, otolaryngology (ENT), and critical care specialists ensures preparedness for immediate airway intervention if the patient deteriorates.
Imaging Techniques
Imaging studies can assist in diagnosis but should never delay airway stabilization.
- Lateral neck radiographs: These may demonstrate the classic “thumbprint sign”, an enlarged and edematous epiglottis that resembles a thumb-shaped shadow. Although suggestive, this finding is neither perfectly sensitive nor specific, and a normal radiograph does not exclude the condition. Radiographs are best reserved for patients with relatively stable airways.
- Flexible fiberoptic nasopharyngolaryngoscopy: This is considered the gold standard for diagnosis. Performed in a controlled setting with airway specialists available, it allows direct visualization of the swollen, erythematous epiglottis and surrounding supraglottic tissues. This procedure provides critical information on the severity of obstruction and guides the decision for intubation.
- Chest X-ray: While not diagnostic of epiglottitis itself, a chest radiograph can help identify concurrent conditions such as aspiration, pneumonia, or pulmonary edema, which may complicate management.
- CT or MRI of the neck: These advanced imaging techniques are rarely necessary and are only considered if the diagnosis is uncertain or if complications such as deep neck space infection, peritonsillar abscess, or epiglottic abscess are suspected. They should only be performed if the patient’s airway is secure.
Laboratory Testing
Laboratory evaluation plays a supporting role, helping to confirm infection and guide antimicrobial therapy.
- Complete blood count (CBC): Leukocytosis with a left shift is common, reflecting acute bacterial infection. However, a normal count does not exclude epiglottitis, particularly in early stages.
- Blood cultures: These should be obtained prior to the initiation of antibiotics whenever possible. Positive cultures may identify the causative organism, such as Haemophilus influenzae type b, Streptococcus pneumoniae, or Staphylococcus aureus. Cultures are particularly useful in epidemiologic tracking and in guiding definitive therapy.
- Epiglottic or throat cultures: Direct swabbing of the oropharynx is not recommended due to the risk of provoking airway obstruction. In some controlled operative settings, cultures may be obtained during intubation or laryngoscopy.
- Rapid antigen detection and polymerase chain reaction (PCR): These molecular tests can rapidly detect Hib and other pathogens. While not routinely necessary in all cases, they are valuable in outbreaks, in unvaccinated populations, or where laboratory confirmation is essential for public health reporting.
- Inflammatory markers (CRP, ESR, procalcitonin): These markers are nonspecific but may aid in assessing the degree of systemic inflammation and monitoring response to treatment. Elevated CRP and procalcitonin levels often correlate with bacterial infection.
- Serologic testing: Rarely indicated, but in research or epidemiologic contexts, antibody assays may be useful in identifying exposure and immunity status to Hib.
Emergency Management
Effective emergency management of epiglottitis requires immediate airway control, targeted medical treatments, and careful decisions about hospital care. Rapid assessment and intervention are critical due to the disease’s potential to cause sudden airway obstruction.
Airway Stabilization
Securing the airway is the most critical step in the management of epiglottitis. Patients often arrive in severe respiratory distress, and airway obstruction may occur with little warning. The decision to intervene must balance the risks of early intubation against the dangers of waiting until complete obstruction occurs.
Endotracheal intubation is the preferred method of airway management, but it must be performed under controlled conditions by highly experienced clinicians, such as anesthesiologists or otolaryngologists. Ideally, intubation should be carried out in an operating room or intensive care unit, where backup surgical airway equipment is available. Fiberoptic or video-assisted laryngoscopy is recommended to improve visualization of the swollen epiglottis and reduce the risk of trauma to the inflamed tissues, which could worsen obstruction.
In some patients, particularly children with rapidly worsening stridor or adults with near-complete obstruction, intubation may not be possible. In these situations, emergency surgical procedures such as tracheostomy (surgical opening in the windpipe) or cricothyrotomy (incision through the cricothyroid membrane) may be lifesaving. Continuous monitoring of oxygen saturation, heart rate, and breathing pattern is mandatory throughout the stabilization process.
A key principle in airway management is the avoidance of agitation. Distressing procedures, unnecessary examinations of the throat, or forcing the patient to lie down can precipitate sudden airway collapse. Patients are often kept sitting upright and allowed to remain in a position of comfort until airway control is secured.
Medical Interventions
Once the airway is stabilized, medical therapy is initiated to treat infection and reduce inflammation. Intravenous broad-spectrum antibiotics are administered immediately, targeting common bacterial causes such as Haemophilus influenzae type b, Streptococcus pneumoniae, and Staphylococcus aureus. Typical first-line regimens include ceftriaxone or ampicillin-sulbactam. In cases where methicillin-resistant Staphylococcus aureus (MRSA) is a concern, vancomycin may be added.
Corticosteroids, such as dexamethasone, are often used to reduce swelling of the epiglottis and surrounding tissues, although their use remains somewhat controversial. When administered, they can decrease airway edema, facilitate earlier extubation, and improve overall comfort.
Supportive care measures are critical. Supplemental oxygen is provided to ensure adequate oxygen levels, though care is taken to avoid agitation from the use of face masks in children. Intravenous fluids help maintain hydration, particularly in patients unable to swallow. Antipyretics such as acetaminophen may be administered to control fever.
Non-invasive ventilation techniques, such as continuous positive airway pressure (CPAP), are generally avoided in epiglottitis due to the risk of worsening obstruction and delayed intubation.
Hospitalization Considerations
All patients with suspected or confirmed epiglottitis require hospital admission to a monitored setting, typically an intensive care unit (ICU) or a high-dependency step-down unit. The decision is guided by the severity of respiratory compromise, need for airway support, and risk of rapid deterioration.
During hospitalization, continuous reassessment of airway patency is performed. Patients who have been intubated are kept under close observation until there is clear evidence of reduced inflammation, improvement in stridor, and stable respiratory function. Extubation should only be attempted after careful evaluation by the treating team, usually after 24 to 72 hours of antibiotic therapy and resolution of swelling, confirmed by direct visualization. Premature removal of the breathing tube carries a high risk of re-obstruction.
Definitive Treatment
Treatment for epiglottitis focuses on rapid infection control and maintaining a secure airway. Immediate interventions and medication management are crucial to prevent respiratory complications.
Antibiotic Therapy
Antibiotic therapy forms the cornerstone of medical management, as most cases of epiglottitis are caused by bacterial pathogens. Early and aggressive administration of intravenous antibiotics is essential to limit the spread of infection, reduce bacterial load, and diminish the associated inflammation of the supraglottic structures.
First-line agents usually include third-generation cephalosporins such as ceftriaxone or cefotaxime, administered for a typical course of 7 to 10 days. These antibiotics provide broad-spectrum coverage against common causative organisms including Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and Streptococcus pyogenes.
In areas where methicillin-resistant Staphylococcus aureus (MRSA) is prevalent, or when clinical suspicion is high, vancomycin or clindamycin may be added to the regimen. Once blood cultures and epiglottic swab results are available, therapy is tailored to the identified pathogen and its antimicrobial sensitivity profile.
Adjunctive Therapies
Adjunctive therapies are often used alongside antibiotics to manage symptoms, reduce inflammation, and stabilize the patient’s airway and overall condition.
- Medications such as dexamethasone are commonly given to reduce airway edema (swelling). While some studies suggest they can shorten the duration of intubation and hospitalization, the evidence remains mixed, and their use is often determined by clinician preference and institutional protocols.
- In cases of partial obstruction, supplemental oxygen may be administered to maintain adequate oxygen levels. Patients with severe obstruction often require intubation or, in rare cases, surgical airway procedures (tracheostomy or cricothyrotomy).
- Because swallowing is usually painful or impossible, patients are kept nil per os (NPO), meaning no food or drink by mouth, until airway stability improves. IV fluids prevent dehydration and maintain electrolyte balance.
- Pain management is important to reduce discomfort and agitation. Agents such as acetaminophen may also lower fever. Sedating medications, however, are used cautiously to avoid depressing the respiratory drive or masking signs of airway compromise.
- In some acute cases, nebulized racemic epinephrine has been used to provide temporary relief of airway obstruction by reducing mucosal swelling. Its effects are short-lived, and it is considered a bridge rather than a substitute for definitive airway contr
Prevention Strategies
Preventing epiglottitis relies mainly on targeted medical interventions and controlling the spread of bacteria. Vaccination and hygiene measures are vital components.
Immunization
The advent of the Hib conjugate vaccine has revolutionized the prevention of epiglottitis. Before its introduction, Hib was the leading cause of life-threatening epiglottitis in children under the age of five. Now, in regions with high immunization coverage, the incidence has dramatically decreased, transforming epiglottitis from a common pediatric emergency into a rare occurrence.
The Hib vaccine is typically administered in a series of doses beginning at 2 months of age, with additional doses at 4 months, 6 months, and a booster at 12–15 months, depending on the national immunization schedule. In many countries, combination vaccines (such as pentavalent or hexavalent formulations) incorporate Hib with other essential immunizations like diphtheria, tetanus, pertussis, polio, and hepatitis B, making delivery more efficient and coverage higher.
For older children, adolescents, or adults who were not vaccinated in infancy, catch-up immunization is recommended in certain high-risk groups. These include immunocompromised individuals (e.g., patients with asplenia, HIV, or malignancy) who are more susceptible to invasive Hib infections. Similarly, travelers to areas with low vaccination rates may benefit from updated Hib protection.
The introduction of Hib vaccination has also provided indirect benefits through herd immunity, lowering the circulation of the pathogen in the community and protecting unvaccinated or partially vaccinated individuals. However, this benefit depends on consistently high coverage rates; lapses in immunization programs can lead to resurgence.
Reducing Transmission
While Hib vaccination addresses the most common cause, other pathogens such as Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus can also cause epiglottitis. Therefore, preventive strategies beyond immunization remain necessary.
Transmission of causative bacteria occurs primarily through respiratory droplets when an infected individual coughs, sneezes, or talks in close proximity. To reduce spread:
- Respiratory hygiene should be emphasized: individuals should cover their mouths and noses when coughing or sneezing, preferably with disposable tissues or the crook of the elbow.
- Frequent hand hygiene with soap and water or alcohol-based sanitizers significantly reduces the chance of introducing pathogens into the upper airway via hand-to-mouth contact.
- Use of masks in healthcare settings or crowded environments can limit the dispersal of infectious droplets, particularly during outbreaks or when managing patients with suspected infections.
Controlling transmission includes prompt treatment of carriers and isolation of affected patients when necessary.
Prognosis and Long-Term Outcomes
The outcome of epiglottitis depends largely on timely treatment and severity at presentation. Patients generally recover well with prompt medical intervention, but some may face residual effects or complications.
Recovery Expectations
With early and effective airway stabilization via intubation or, in rare cases, surgical intervention together with prompt administration of intravenous antibiotics, patients often show substantial clinical improvement within 24 to 48 hours. Swelling of the epiglottis usually begins to subside within two to three days of treatment, and most patients can transition to oral antibiotics after initial stabilization.
Typical hospital stays last 3 to 7 days, though duration may vary depending on the severity of airway obstruction, the patient’s baseline health status, and the development of complications. Those requiring prolonged intubation or tracheostomy may need extended hospitalization and specialized airway care.
In the majority of cases, long-term respiratory complications are uncommon. Once the infection resolves, patients generally regain full airway function without chronic sequelae. Nonetheless, follow-up care is essential to monitor for residual inflammation, airway narrowing (subglottic stenosis), or rare recurrence.
Although most patients achieve full recovery, some may experience complications during or after the acute illness:
- Endotracheal intubation or tracheostomy, while lifesaving, may result in localized scarring or irritation, occasionally causing temporary hoarseness or swallowing difficulties.
- Spread of infection can lead to deep neck space abscesses, pneumonia, or septicemia, all of which prolong recovery.
- Rarely, severe hypoxia before airway stabilization can result in hypoxic brain injury.
- While uncommon, recurrent epiglottitis can occur, especially in individuals with underlying immune deficiencies or incomplete Hib immunization.
Prognosis is therefore excellent when airway compromise is managed promptly, but morbidity and mortality rise sharply if diagnosis is delayed.
Epiglottitis in Special Populations
Certain populations experience distinct risks and clinical features in epiglottitis. Age-specific anatomical and immune factors affect presentation, diagnosis, and management strategies.
Pediatric Considerations
In children, epiglottitis remains a true airway emergency due to anatomical and physiological differences: the smaller airway diameter makes even minor swelling critical, and children can progress from mild distress to complete obstruction in a matter of hours. Clinical vigilance is especially important in children under five years of age, though widespread Hib vaccination has dramatically reduced pediatric incidence.
Children often require longer observation periods even after airway stabilization, as their airway remains vulnerable to rapid changes. Outcomes are generally excellent if intervention occurs early, but delayed recognition still carries significant risks.
Adult Presentations
In adults, the course of epiglottitis tends to be more insidious, with symptoms such as sore throat, odynophagia (painful swallowing), and dysphagia often preceding overt respiratory distress. While complete airway obstruction is less common than in children, adults can still deteriorate quickly, especially those with comorbidities such as diabetes, chronic respiratory conditions, or immune suppression.
Adults who smoke or consume alcohol excessively may also have increased susceptibility, possibly due to chronic airway irritation and impaired mucosal defense. In this group, prognosis remains favorable with timely management, but close monitoring is essential to identify early signs of airway compromise.
In older adults and immunocompromised populations, outcomes can be more variable. Reduced immune response, multiple comorbidities, and delayed presentation often complicate management. These patients may have atypical presentations without the classic signs of stridor or drooling, which increases the risk of misdiagnosis. Mortality rates in these groups are higher than in otherwise healthy adults or children, underscoring the importance of early suspicion and aggressive intervention.