Epiglottitis

Swelling that can close the airway within hours. Do not look in the throat, do not lie them down, call 999.

What it is

Inflammation and swelling of the epiglottis, the flap above the voice box, which can obstruct the airway completely.

It was a classic childhood emergency until the Hib vaccine, introduced in the UK in 1992, made it rare in children. It still occurs, in unvaccinated children and increasingly in adults, where other bacteria are usually responsible.

It is a true airway emergency. The airway can close within hours, and the safest place for it to happen is an operating theatre with an anaesthetist present.

Two instructions matter and both are counter-intuitive. **Do not examine the throat**, with a spatula, a torch or a swab, because it can trigger complete obstruction. And **do not lie the person down**; let them sit in whatever position they have chosen, usually upright and leaning forward, which is the position keeping their airway open.

Keeping a child calm is genuinely part of the treatment. Distress worsens obstruction, so no cannulas, no examinations, and staying with a parent until an anaesthetist is present.

The picture in a child is rapid: hours from well to critically ill, with drooling, a muffled voice and sitting upright refusing to lie back.

Signs you might notice

Severe sore throat with difficulty and pain on swallowing.

Drooling, because swallowing saliva hurts too much.

A muffled or hot-potato voice, rather than hoarseness.

Sitting upright, leaning forward, chin pushed out, refusing to lie down.

Noisy breathing or stridor, a harsh sound on breathing in. This is a late and ominous sign.

High fever, looking very unwell, anxious or agitated.

Usually no cough, which helps distinguish it from croup.

**999 immediately.** Do not look in the throat, do not lie them down, do not try to give anything to drink, and keep them calm.

Adults present more slowly but the same rules apply.

How it can affect day-to-day life

The rarity is the danger: clinicians and parents alike may not have seen a case, and a severe sore throat is usually nothing.

The distinguishing features from ordinary tonsillitis are drooling, the muffled voice, the posture, and how quickly it developed.

Croup is the other thing it is confused with. Croup has a barking cough and mostly affects younger children; epiglottitis has no cough and a much more toxic-looking child.

Hib vaccination is the prevention, and this is one of the clearest examples of a vaccine having removed a common cause of childhood death within living memory. That is worth saying to families weighing up immunisation.

Adults who smoke, who are immunosuppressed, or who have had a thermal or chemical injury to the throat are at higher risk.

After recovery, close contacts of a confirmed Hib case may need preventive antibiotics.

Supporting someone well

Call 999 for severe sore throat with drooling, a muffled voice, or someone sitting forward refusing to lie down.

Do not look in the throat. Do not use a spatula, a torch or a swab.

Do not lie the person down. Let them sit however they are comfortable.

Keep a child calm and with a parent. Distress makes the obstruction worse.

Do not attempt to give food or drink.

Say epiglottitis to the call handler and at the door.

Keep Hib immunisation up to date, including catch-up for older children who missed it.

Afterwards, ask whether contacts need preventive antibiotics.

Where to get help

999 immediately. This is an ambulance, not a car journey.

The hospital anaesthetic and ENT teams manage the airway.

ENT UK publish information on throat emergencies.