Epiglottitis: symptoms, causes, treatment and when to call 999

The epiglottis is a flap of tissue that sits beneath the tongue at the back of the throat. nidirect explains that its main function is to close over the windpipe while you eat, to prevent food entering your airway. The NHS describes epiglottitis as swelling of this flap, which can block the windpipe and make it difficult to breathe.

nidirect notes that epiglottitis is often caused by an infection but can sometimes occur as a result of a throat injury, and that it can be fatal if the throat becomes completely blocked, though most people make a full recovery with treatment.

The NHS says the main symptom is finding it very difficult to breathe, which usually comes on quickly. Your breathing may be very fast or slow, may be easier when you lean forward, and may make a high-pitched, rasping sound as you breathe in. A child with epiglottitis may not want to lie down and will lean forward with their neck pushed out while sitting.

Other symptoms the NHS lists include a very sore throat, a high temperature, a hoarse (croaky) voice, painful and difficult swallowing, drooling, pale, grey or blue-tinged skin (cyanosis), and being extremely tired, very restless or irritable. nidirect adds that the symptoms usually develop quickly and get rapidly worse, although in older children and adults they can develop over a few days.

The NHS says to call 999 if you think you or your child may have epiglottitis. Stay upright until help arrives, as lying down can make symptoms worse. Do not drive yourself to A&E; the person you speak to at 999 will give you advice.

nidirect adds that while waiting for an ambulance you should not try to examine your child's throat, place anything inside their mouth or lay them on their back, as this may make symptoms worse, and that it is important to keep them calm and try not to cause panic or distress.

The NHS says you will need treatment in hospital. You will usually need oxygen through a tube in your nose or a face mask. You may also need a breathing tube put down your throat or into a hole made in your neck (tracheostomy) if you are finding it very difficult to breathe. You will be given antibiotics through a vein if an infection has caused your symptoms.

nidirect explains that the first thing the medical team does is secure the airway, with an oxygen mask, then a tube past the epiglottis into the windpipe if needed, and in severe cases a small cut in the neck at the front of the windpipe (tracheostomy), which can be carried out under local or general anaesthetic. Fluids are given into a vein until the person can swallow, and once the airway is secure some tests may be carried out.

The NHS says tests may include a laryngoscopy (a tube with a camera to look at the throat), a throat swab, blood tests, and an X-ray or CT scan.

The NHS says epiglottitis is usually caused by a type of bacteria called Haemophilus influenzae type b (Hib), which is spread through coughing and sneezing, or by touching objects and surfaces that carry it. nidirect adds that Hib can also cause pneumonia and meningitis and spreads in the same way as a cold or flu virus.

Other causes the NHS lists include injuring the throat, such as being hit in the throat or drinking very hot liquids, and smoking, especially illegal drugs like cannabis or crack cocaine. You may also have a higher chance of getting epiglottitis if you have a weakened immune system.

The NHS says the 6-in-1 vaccine, which includes protection against Hib, is offered to children as part of the NHS vaccination schedule, in 4 doses at 8 weeks, 12 weeks, 16 weeks and 18 months old. If you or your child were not vaccinated when young, ask a GP about how to get vaccinated. Not smoking can also reduce your chance of getting epiglottitis.

The NHS page on Hib says Hib can cause meningitis, sepsis, epiglottitis and pneumonia, and that babies and children are most at risk of becoming seriously ill. Schedules change over time, so check the current NHS vaccination schedule or ask your GP surgery.

Noisy breathing in children can have other causes besides epiglottitis, and it can be hard to tell them apart. The NHS advice is clear that if you think you or your child may have epiglottitis, you should call 999 rather than wait. See our pages on childhood croup and paediatric epiglottitis for more detail.

The NHS says to call 999 if a child is limp, floppy or not responding normally, or has blue, grey or pale skin, lips or tongue, in any severe breathing problem.

Epiglottitis is treated as an emergency in NHS hospitals, with airway specialists, anaesthetists and ENT or paediatric teams. It is not something to wait out or book a private appointment for. If you think you or your child has it, call 999. Follow-up, including checking that vaccinations are up to date, is arranged afterwards through your GP.