Intubation tube used to ensure airways are clear

The epiglottis is a piece of cartilage that sticks up at the back of the tongue to stop food from entering the windpipe (trachea) when swallowing. Epiglottitis is an uncommon bacterial infection (most commonly by Haemophilus influenzae B – HiB) of the epiglottis that is an acute medical emergency requiring urgent hospitalisation, as it can swell up rapidly and block the throat.

Infection is most common in children under five years of age who develop a very sore throat, fever and obvious illness. In young children, if the epiglottis swells excessively, or is disturbed by trying to eat solids or by the tongue depressing stick of a doctor examining the mouth, it can cover the windpipe completely and rapidly cause death through suffocation. For this reason a doctor will give the throat only a cursory examination before arranging the immediate transfer of the child to hospital. If the airway is obstructed in hospital, an emergency tracheotomy (an operation to make a hole into the wind pipe through the front of the neck) is performed to allow the child to breathe.

The diagnosis is confirmed by a side-on X-ray of the neck that shows the swollen epiglottis. Throat swabs are taken to identify the infecting bacteria and sometimes blood tests are also performed.

Antibiotics are given to cure the infection and paracetamol to reduce fever and pain. Some hospitals routinely anaesthetise children and put a tube through the mouth or nose and down the throat to prevent the airway from blocking. The infection usually settles in a few days, and provided there has been no airway obstruction, the outcome is excellent.

A series of vaccinations against Haemophilus influenzae B (HiB) is now routinely given to all children starting at two months of age.

Illustration showing epiglottis, vocal fold and trachea

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