Epiglottitis is an acute inflammatory condition affecting the epiglottis and surrounding structures in the throat. The epiglottis acts as a valve, preventing food and liquids from entering the windpipe (trachea) when you swallow. When this tissue becomes inflamed and swollen, it can obstruct the airway, making breathing difficult. While epiglottitis has become less common since the introduction of the Haemophilus influenzae type b (Hib) vaccine, it remains a medical emergency that can affect both children and adults. The condition may progress from initial symptoms to airway obstruction, making prompt medical evaluation important for anyone with suspected epiglottitis.
Epiglottitis in Singapore
Epiglottitis is a potentially serious condition that requires prompt medical attention. This condition involves inflammation and swelling of the epiglottis—the small cartilage flap that covers your windpipe during swallowing. If you experience severe throat pain, difficulty swallowing, or breathing problems, immediate medical evaluation is essential. ENT specialists can provide emergency assessment and treatment for epiglottitis, aiming to protect your airway and manage the condition appropriately. Individual cases may vary, and treatment outcomes depend on various factors, including the severity of the condition and the timing of medical intervention.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is Epiglottitis?
Types of Epiglottitis
Acute Epiglottitis
This is a form that can develop rapidly over hours to days. Acute epiglottitis involves sudden inflammation of the epiglottis and may lead to airway obstruction. This type requires immediate emergency treatment and can affect previously healthy individuals.
Chronic Epiglottitis
A form that develops gradually over weeks to months, chronic epiglottitis presents with recurring episodes of throat discomfort and mild swelling. While less urgent than acute epiglottitis, it still requires medical evaluation to prevent complications and identify underlying causes.
Infectious Epiglottitis
Caused by bacterial, viral, or fungal infections, this type was historically associated with Haemophilus influenzae type b. Currently, other bacteria, such as Streptococcus and Staphylococcus species, may be involved. Viral causes can include herpes simplex and varicella-zoster viruses.
Non-infectious Epiglottitis
This type can result from thermal injury (hot liquids or steam), chemical burns, trauma to the throat, or allergic reactions. Non-infectious epiglottitis can be as concerning as infectious forms and requires urgent medical attention.
Causes & Risk Factors
Causes
The causes of epiglottitis include:
- Bacterial infections: Streptococcus pneumoniae, Staphylococcus aureus, and beta-haemolytic streptococci are bacterial causes following widespread Hib vaccination
- Viral infections: Herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, and parainfluenza viruses
- Fungal infections: In immunocompromised patients, Candida species can cause epiglottitis
- Thermal injury: Ingestion of hot foods or liquids, or inhalation of hot steam or smoke
- Chemical irritation: Ingestion of caustic substances
- Direct trauma: Foreign body ingestion, endoscopic procedures, or external neck trauma
- Allergic reactions: Allergic responses affecting the throat tissues
Risk Factors
Several factors may increase the risk of developing epiglottitis:
- Incomplete vaccination: Missing or delayed Hib vaccination may increase risk, particularly in children
- Weakened immune system: HIV/AIDS, chemotherapy, chronic steroid use, or diabetes mellitus
- Age factors: Certain age groups, including young children and older adults, may face a higher risk
- Male gender: Men may be affected more often than women
- Seasonal patterns: Higher incidence during winter months
- Smoking: Chronic irritation of the throat tissues may increase susceptibility
- Recent upper respiratory infection: Can predispose to secondary bacterial invasion
Signs & Symptoms
Early Symptoms
- Severe sore throat that develops suddenly
- High fever (often above 39°C)
- Difficulty and pain when swallowing (dysphagia)
- Muffled or hoarse voice
- General feeling of illness and anxiety
Progressive Symptoms
- Drooling due to inability to swallow saliva
- Stridor (high-pitched breathing sound)
- Sitting upright and leaning forward (tripod position)
- Difficulty breathing that worsens when lying down
- Restlessness and irritability, especially in children
- Refusal to eat or drink
Severe/Emergency Symptoms
- Severe respiratory distress with use of accessory breathing muscles
- Cyanosis (bluish discolouration of lips and fingernails)
- Decreased breath sounds
- Confusion or altered mental state
- Complete inability to speak or cry (in children)
- Loss of consciousness
Symptoms of epiglottitis can develop rapidly, though progression may vary by individual. The presentation may include dysphagia (difficulty swallowing), dysphonia (voice changes), drooling, and distress.
Experiencing these symptoms?
Consider consulting with an ENT specialist for evaluation and appropriate management.
When to See an ENT Specialist
Epiglottitis is always a medical emergency requiring immediate evaluation. Seek emergency medical care immediately if you or your child experiences severe throat pain with difficulty breathing, drooling, or a high fever. Do not attempt to examine the throat yourself or lie the person down, as this could trigger complete airway obstruction.
Call emergency services (999 in the UK) if you notice stridor, cyanosis, severe breathing difficulty, or if the person cannot swallow their own saliva. Time is critical—delays in treatment can result in complete airway obstruction.
During your emergency consultation, the healthcare professional can prioritise securing the airway while conducting a careful evaluation. The examination is performed with extreme caution, with emergency airway equipment immediately available. Parents should remain calm and keep children upright and comfortable during transport to the hospital.
For those with recurrent throat infections or a history of epiglottitis, regular follow-up with an ENT specialist can help identify risk factors and implement preventive strategies.
Diagnosis & Testing Methods
Diagnosis of epiglottitis requires careful clinical evaluation with immediate readiness for airway intervention. ENT specialists use a systematic approach prioritising patient safety while confirming the diagnosis.
- Clinical Assessment forms the foundation of diagnosis. The characteristic presentation of severe sore throat, drooling, and respiratory distress in a toxic-appearing patient strongly suggests epiglottitis. Physical examination is performed cautiously, avoiding any manipulation that could trigger airway obstruction.
- Flexible Nasopharyngoscopy allows direct visualisation of the inflamed, cherry-red epiglottis when performed by an ENT specialist. This procedure is performed with complete resuscitation equipment available and, for safety, often in an operating theatre setting.
- Lateral Neck X-ray may show the characteristic “thumb sign”—a swollen epiglottis resembling a thumbprint. While helpful, X-rays should never delay definitive airway management in unstable patients.
- Blood Tests, including complete blood count, blood cultures, and inflammatory markers, help identify the causative organism and guide antibiotic selection. These are typically performed after airway security is ensured.
- Throat Cultures obtained during intubation or from the epiglottis surface can identify specific bacterial or viral pathogens, allowing targeted antimicrobial therapy.
Treatment Options Overview
Emergency Airway Management
The first priority in the treatment of epiglottitis is securing the airway. ENT specialists coordinate with anaesthesiologists to perform controlled intubation in the operating theatre when possible. Some patients may require emergency tracheostomy if intubation proves difficult. Continuous monitoring and humidified oxygen can support breathing while reducing airway irritation.
Intravenous Antibiotics
Broad-spectrum antibiotics are typically started upon diagnosis, before culture results are available. Standard regimens may include third-generation cephalosporins (ceftriaxone or cefotaxime) combined with anti-staphylococcal coverage. Treatment may continue intravenously, followed by oral antibiotics to complete the prescribed course.
Corticosteroids
Systemic corticosteroids like dexamethasone or methylprednisolone may help reduce epiglottic swelling and inflammation. While their benefit remains under clinical evaluation, some specialists include steroids in the treatment protocol, particularly for severe cases. The anti-inflammatory effects may support recovery.
Supportive Medical Care
Intravenous fluids can maintain hydration when swallowing is difficult. Antipyretics may help control fever and improve comfort. Anxiolytics may be carefully administered to reduce anxiety without suppressing respiratory drive. Pain management using appropriate analgesics aims to ensure patient comfort during recovery.
Nebulised Epinephrine
Racemic epinephrine nebulisation may provide temporary relief of airway swelling through vasoconstriction. While not a definitive treatment, it can give time while preparing for definitive airway management. Close monitoring is essential as rebound swelling can occur.
Intensive Care Monitoring
Patients with epiglottitis may require ICU-level monitoring until the airway swelling resolves. This includes continuous pulse oximetry, cardiac monitoring, and frequent clinical assessments. Patients may show improvement with appropriate treatment.
Every patient’s condition is unique.
Our ENT Specialist can assess your specific situation and recommend the most suitable treatment.
Complications if Left Untreated
Without prompt treatment, epiglottitis can progress to complete airway obstruction, leading to respiratory arrest. This condition requires immediate medical attention.
Secondary complications may include aspiration pneumonia due to inability to protect the airway, septic shock from bacterial spread into the bloodstream, and meningitis when the infection spreads to the central nervous system. Lung abscess, empyema, and mediastinitis are possible but less common complications of untreated epiglottitis.
Long-term complications may include vocal cord dysfunction from prolonged intubation, subglottic stenosis that might require surgical correction, and psychological effects, particularly in children who experience severe respiratory distress. Patients may develop anxiety related to swallowing or breathing difficulties. Early recognition and treatment can help reduce these risks. Individual outcomes may vary, and patients should seek immediate medical attention if symptoms develop.
Prevention
Prevention of epiglottitis centres on vaccination and risk reduction strategies. The Hib vaccine, part of Singapore’s National Childhood Immunisation Schedule, has helped reduce the incidence of epiglottitis. Children may receive scheduled doses at 2, 4, 6, and 18 months of age as part of the recommended immunisation programme.
Adults may maintain current vaccinations, including annual influenza shots and pneumococcal vaccines, as recommended by healthcare professionals. These can help reduce the risk of respiratory infections that may lead to epiglottitis.
Practise good hygiene, including frequent handwashing, avoiding close contact with people who have respiratory infections, and not sharing eating utensils or drinking glasses. Children can be taught to cover coughs and sneezes properly.
Chronic health conditions, particularly diabetes and immune system disorders, should be managed effectively under medical supervision. Stopping smoking can help reduce throat irritation and infection risk. Prompt medical consultation for upper respiratory infections may help prevent spread to the epiglottis.
For those with prior episodes of epiglottitis, consultation with an ENT specialist can help identify and address underlying risk factors. Individual risk factors and prevention strategies may vary. Consult with a healthcare professional for personalised advice.
For Singaporeans & Singapore Permanent Residents
Medisave & Insurance Shield Plan approved
Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.
Frequently Asked Questions (FAQ)
How quickly does epiglottitis develop and become dangerous?
Epiglottitis can progress rapidly, with symptoms potentially developing over hours. The condition can lead to airway obstruction and is considered a medical emergency. The progression may vary between individuals, with children potentially experiencing a faster onset than adults. Any combination of severe throat pain, difficulty swallowing, drooling, and breathing problems requires immediate emergency evaluation.
Can adults get epiglottitis even if they were vaccinated as children?
Yes, adults can develop epiglottitis despite childhood Hib vaccination. While the vaccine has reduced Hib-related cases, other bacteria, viruses, and non-infectious causes can still trigger epiglottitis in adults. Adult epiglottitis can occur in vaccinated populations. Risk factors like smoking, immune suppression, and chronic health conditions may increase adult susceptibility. The presentation may differ from child to child, but the condition remains serious.
What is the difference between epiglottitis and croup?
While both conditions affect the airway, they differ in location, severity, and treatment urgency. Epiglottitis involves inflammation of the epiglottis and is a medical emergency requiring immediate intervention. Croup affects the larynx and trachea, causing a characteristic barking cough and can be managed with steroids and supportive care. Epiglottitis typically presents with drooling and severe dysphagia without significant coughing. The conditions also differ in age distribution and causative organisms.
How long does recovery from epiglottitis take?
With prompt treatment, patients may show improvement following the start of antibiotics and supportive care. Intubated patients may have their breathing tubes removed as swelling subsides. Recovery typically occurs with appropriate antibiotic therapy. Return to normal activities may be possible once the antibiotic course is completed and symptoms have resolved. Follow-up with an ENT specialist can help monitor healing and address any concerns.
Can epiglottitis recur after successful treatment?
Recurrence of epiglottitis is uncommon but possible. When recurrence happens, it may indicate an underlying predisposing factor such as an immune deficiency, anatomical abnormality, or chronic infection source. Patients with recurrent epiglottitis may require evaluation by an ENT specialist to identify and address underlying causes. This may include immunological testing, imaging studies, and examination of the upper airway structures.
What should I do if I suspect someone has epiglottitis?
Call emergency services (995) immediately and keep the person calm and upright. Do not attempt to look in their throat or lay them down, as this could trigger complete airway obstruction. Allow them to maintain whatever position is comfortable for breathing, usually sitting upright and leaning forward. Avoid giving food or drinks. If they’re drooling, provide tissues, but don’t encourage them to swallow. Stay with them and monitor their breathing while waiting for emergency services.
Conclusion
Epiglottitis remains a serious medical emergency. Recognising the warning signs—severe throat pain, difficulty swallowing, drooling, and breathing difficulties—can be significant for prompt medical intervention. While the condition can be concerning, modern medical care aims to provide effective outcomes when treatment begins promptly. Our ENT specialist in Singapore has experience managing both emergency and follow-up care for epiglottitis, providing treatment from acute intervention through recovery.
Take the First Step Towards Better Health
Living with recurrent throat infections or concerns about epiglottitis can be concerning, but you don’t have to face it alone. Our ENT Specialist has experience diagnosing and treating epiglottitis using current evidence-based approaches.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He underwent his subspecialty training in Rhinology (Nose & Sinus conditions) and Endoscopic Skull Base Surgery at the renowned St Paul’s Sinus Center, part of the University of British Columbia in Vancouver, Canada. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
Make an Enquiry
Fill up the form and our friendly clinic staff will get back to you promptly.
Our Location
A Specialist Clinic for Sinus, Snoring & ENT
38 Irrawaddy Road #08-45
Mount Elizabeth Novena Hospital
Singapore 329563
Mon – Fri: 9:00 am – 5:00 pm
Sat: 8:30 am – 12:00 pm