Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Epiglottitis (supraglottitis): Clinical features and diagnosis

Charles R Woods, MD, MS
Section Editors
Morven S Edwards, MD
Glenn C Isaacson, MD, FAAP
Gary R Fleisher, MD
Deputy Editor
James F Wiley, II, MD, MPH


The pathogenesis, etiology, and clinical features of epiglottitis (also called supraglottitis) will be reviewed here. The treatment and prevention of epiglottitis are discussed separately. (See "Epiglottitis (supraglottitis): Treatment and prevention".)


Epiglottitis is inflammation of the epiglottis and adjacent supraglottic structures [1]. Without treatment, epiglottitis can progress to life-threatening airway obstruction. A rapid overview of the recognition and management of epiglottitis in children is provided in the table (table 1).


The epiglottis forms the back wall of the vallecular space below the base of the tongue (figure 1). It is connected to the thyroid cartilage and hyoid bone by ligaments. The epiglottis consists of a thin cartilage that is covered anteriorly by a stratified squamous epithelial layer. This squamous layer also covers the superior third of the posterior surface, where it merges with respiratory epithelium that extends into the larynx. The epithelium and lamina propria beneath are tightly adherent on the posterior (laryngeal) surface and loosely attached on the anterior (lingual) surface. This creates a potential space on the lingual surface for edema fluid to collect.


Infectious epiglottitis is a cellulitis of the epiglottis, aryepiglottic folds, and other adjacent tissues. It results from bacteremia and/or direct invasion of the epithelial layer by the pathogenic organism [2,3]. The posterior nasopharynx is the primary source of pathogens in epiglottitis. Microscopic trauma to the epithelial surface (eg, mucosal damage during a viral infection or from food during swallowing) may be a predisposing factor.

Swelling of the epiglottis results from edema and accumulation of inflammatory cells in the potential space between the squamous epithelial layer and the epiglottal cartilage. The lingual surface of the epiglottis and periepiglottic tissues have abundant networks of lymphatic and blood vessels that facilitate spread of infection and the subsequent inflammatory response. Once infection begins, swelling rapidly progresses to involve the entire supraglottic larynx (including the aryepiglottic folds and arytenoids) [3,4]. The subglottic regions generally are not affected; swelling is halted by the tightly bound epithelium at the level of the vocal cords.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jun 23, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Rafei K, Lichenstein R. Airway infectious disease emergencies. Pediatr Clin North Am 2006; 53:215.
  2. Cherry JD. Epiglottitis (supraglottitis). In: Textbook of Pediatric Infectious Diseases, 6th, Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL. (Eds), Saunders, Philadelphia 2009. p.244.
  3. Harper MB, Fleisher GR. Infectious disease emergencies. In: Textbook of Pediatric Emergency Medicine, 6th, Fleisher GR, Ludwig S, Henretig FM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.887.
  4. Sato S, Kuratomi Y, Inokuchi A. Pathological characteristics of the epiglottis relevant to acute epiglottitis. Auris Nasus Larynx 2012; 39:507.
  5. Glynn F, Fenton JE. Diagnosis and management of supraglottitis (epiglottitis). Curr Infect Dis Rep 2008; 10:200.
  6. Stroud RH, Friedman NR. An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis. Am J Otolaryngol 2001; 22:268.
  7. Shah RK, Roberson DW, Jones DT. Epiglottitis in the Hemophilus influenzae type B vaccine era: changing trends. Laryngoscope 2004; 114:557.
  8. Tanner K, Fitzsimmons G, Carrol ED, et al. Haemophilus influenzae type b epiglottitis as a cause of acute upper airways obstruction in children. BMJ 2002; 325:1099.
  9. Devlin B, Golchin K, Adair R. Paediatric airway emergencies in Northern Ireland, 1990-2003. J Laryngol Otol 2007; 121:659.
  10. González Valdepeña H, Wald ER, Rose E, et al. Epiglottitis and Haemophilus influenzae immunization: the Pittsburgh experience--a five-year review. Pediatrics 1995; 96:424.
  11. Solomon P, Weisbrod M, Irish JC, Gullane PJ. Adult epiglottitis: the Toronto Hospital experience. J Otolaryngol 1998; 27:332.
  12. Somenek M, Le M, Walner DL. Membranous laryngitis in a child. Int J Pediatr Otorhinolaryngol 2010; 74:704.
  13. Sivakumar S, Latifi SQ. Varicella with stridor: think group A streptococcal epiglottitis. J Paediatr Child Health 2008; 44:149.
  14. Mayo-Smith MF, Spinale JW, Donskey CJ, et al. Acute epiglottitis. An 18-year experience in Rhode Island. Chest 1995; 108:1640.
  15. Frantz TD, Rasgon BM, Quesenberry CP Jr. Acute epiglottitis in adults. Analysis of 129 cases. JAMA 1994; 272:1358.
  16. Kucera CM, Silverstein MD, Jacobson RM, et al. Epiglottitis in adults and children in Olmsted County, Minnesota, 1976 through 1990. Mayo Clin Proc 1996; 71:1155.
  17. Torkkeli T, Ruoppi P, Nuutinen J, Kari A. Changed clinical course and current treatment of acute epiglottitis in adults a 12-year experience. Laryngoscope 1994; 104:1503.
  18. Lacroix J, Gauthier M, Lapointe N, et al. Pseudomonas aeruginosa supraglottitis in a six-month-old child with severe combined immunodeficiency syndrome. Pediatr Infect Dis J 1988; 7:739.
  19. Walsh TJ, Gray WC. Candida epiglottitis in immunocompromised patients. Chest 1987; 91:482.
  20. Myer CM 3rd. Candida epiglottitis: clinical implications. Am J Otolaryngol 1997; 18:428.
  21. Abou Zahr A, Saad Aldin E, Yunyongying P. Histoplasma epiglottitis in a patient with Crohn's disease maintained on infliximab, prednisone, and azathioprine. Int J Infect Dis 2013; 17:e650.
  22. Harjacek M, Kornberg AE, Yates EW, Montgomery P. Thermal epiglottitis after swallowing hot tea. Pediatr Emerg Care 1992; 8:342.
  23. Kulick RM, Selbst SM, Baker MD, Woodward GA. Thermal epiglottitis after swallowing hot beverages. Pediatrics 1988; 81:441.
  24. Lai SH, Wong KS, Liao SL, Chou YH. Non-infectious epiglottitis in children: two cases report. Int J Pediatr Otorhinolaryngol 2000; 55:57.
  25. Kavanagh KR, Batti JS. Traumatic epiglottitis after foreign body ingestion. Int J Pediatr Otorhinolaryngol 2008; 72:901.
  26. Mayo-Smith MF, Spinale J. Thermal epiglottitis in adults: a new complication of illicit drug use. J Emerg Med 1997; 15:483.
  27. Rosbe KW, Perez-Atayde AR, Roberson DW, Kenna M. Pathology forum: quiz case 1. Diagnosis: posttransplant lymphoproliferative disease (PTLD) of the epiglottis. Arch Otolaryngol Head Neck Surg 2000; 126:1153; discussion 1157.
  28. de Diego JI, Prim MP, Hardisson D, et al. Graft-vs-host disease as a cause of enlargement of the epiglottis in an immunocompromised child. Arch Otolaryngol Head Neck Surg 2001; 127:439.
  29. Centers for Disease Control and Prevention (CDC). Progress toward elimination of Haemophilus influenzae type b invasive disease among infants and children--United States, 1998-2000. MMWR Morb Mortal Wkly Rep 2002; 51:234.
  30. Garpenholt O, Hugosson S, Fredlund H, et al. Epiglottitis in Sweden before and after introduction of vaccination against Haemophilus influenzae type b. Pediatr Infect Dis J 1999; 18:490.
  31. Garner D, Weston V. Effectiveness of vaccination for Haemophilus influenzae type b. Lancet 2003; 361:395.
  32. Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol 2008; 122:818.
  33. McVernon J, Slack MP, Ramsay ME. Changes in the epidemiology of epiglottitis following introduction of Haemophilus influenzae type b (Hib) conjugate vaccines in England: a comparison of two data sources. Epidemiol Infect 2006; 134:570.
  34. Senior BA, Radkowski D, MacArthur C, et al. Changing patterns in pediatric supraglottitis: a multi-institutional review, 1980 to 1992. Laryngoscope 1994; 104:1314.
  35. Wood N, Menzies R, McIntyre P. Epiglottitis in Sydney before and after the introduction of vaccination against Haemophilus influenzae type b disease. Intern Med J 2005; 35:530.
  36. Nakamura H, Tanaka H, Matsuda A, et al. Acute epiglottitis: a review of 80 patients. J Laryngol Otol 2001; 115:31.
  37. Gorelick MH, Baker MD. Epiglottitis in children, 1979 through 1992. Effects of Haemophilus influenzae type b immunization. Arch Pediatr Adolesc Med 1994; 148:47.
  38. Briem B, Thorvardsson O, Petersen H. Acute epiglottitis in Iceland 1983-2005. Auris Nasus Larynx 2009; 36:46.
  39. Faden H. The dramatic change in the epidemiology of pediatric epiglottitis. Pediatr Emerg Care 2006; 22:443.
  40. Shah RK, Nussenbaum B, Kienstra M, et al. Wrong-site sinus surgery in otolaryngology. Otolaryngol Head Neck Surg 2010; 143:37.
  41. Annual Estimates of the Population by Five-Year Age Groups and Sex for the United States: April 1, 2000 to July 1, 2006 (NC-EST2006-01). http://www.census.gov/popest/national/asrh/NC-EST2006-sa.html (Accessed on April 22, 2011).
  42. Lee AC, Lam SY. Life threatening acute epiglottitis in acute leukemia. Leuk Lymphoma 2002; 43:665.
  43. Cocks HC, Johnson IJ. Acute epiglottitis: a presentation of haemophagocytic lymphohistiocytosis. J Laryngol Otol 2001; 115:819.
  44. Murray JC, Chiu JK, Dorfman SR, Ogden AK. Epiglottitis following preparation for allogeneic bone marrow transplantation. Bone Marrow Transplant 1995; 15:997.
  45. Charuvanij S, Houghton KM. Acute epiglottitis as the initial presentation of pediatric Systemic Lupus Erythematosus. Pediatr Rheumatol Online J 2009; 7:19.
  46. Ambrosino DM, Schiffman G, Gotschlich EC, et al. Correlation between G2m(n) immunoglobulin allotype and human antibody response and susceptibility to polysaccharide encapsulated bacteria. J Clin Invest 1985; 75:1935.
  47. Granoff DM, Pandey JP, Boies E, et al. Response to immunization with Haemophilus influenzae type b polysaccharide-pertussis vaccine and risk of Haemophilus meningitis in children with the Km(1) immunoglobulin allotype. J Clin Invest 1984; 74:1708.
  48. Tejani A, Mahadevan R, Dobias B, et al. Occurrence of HLA types in H. influenzae type B disease. Tissue Antigens 1981; 17:205.
  49. Whisnant JK, Rogentine GN, Gralnick MA, et al. Host factors and antibody response Haemophilus influenza type b meningitis and epiglottitis. J Infect Dis 1976; 133:448.
  50. Ng HL, Sin LM, Li MF, et al. Acute epiglottitis in adults: a retrospective review of 106 patients in Hong Kong. Emerg Med J 2008; 25:253.
  51. Chang YL, Lo SH, Wang PC, Shu YH. Adult acute epiglottitis: experiences in a Taiwanese setting. Otolaryngol Head Neck Surg 2005; 132:689.
  52. Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope 1990; 100:183.
  53. Park KW, Darvish A, Lowenstein E. Airway management for adult patients with acute epiglottitis: a 12-year experience at an academic medical center (1984-1995). Anesthesiology 1998; 88:254.
  54. BERENBERG W, KEVY S. Acute epiglottitis in childhood; a serious emergency, readily recognized at the bedside. N Engl J Med 1958; 258:870.
  55. Losek JD, Dewitz-Zink BA, Melzer-Lange M, Havens PL. Epiglottitis: comparison of signs and symptoms in children less than 2 years old and older. Ann Emerg Med 1990; 19:55.
  56. RABE EF. Infectious croup; Hemophilus influenzae type B croup. Pediatrics 1948; 2:559.
  57. Johnson GK, Sullivan JL, Bishop LA. Acute epiglottitis. Review of 55 cases and suggested protocol. Arch Otolaryngol 1974; 100:333.
  58. Battaglia JD, Lockhart CH. Management of acute epiglottitis by nasotracheal intubation. Am J Dis Child 1975; 129:334.
  59. Tibballs J, Watson T. Symptoms and signs differentiating croup and epiglottitis. J Paediatr Child Health 2011; 47:77.
  60. Hébert PC, Ducic Y, Boisvert D, Lamothe A. Adult epiglottitis in a Canadian setting. Laryngoscope 1998; 108:64.
  61. Oropharyngeal examination for suspected epiglottitis. Am J Dis Child 1988; 142:1261.
  62. Damm M, Eckel HE, Jungehülsing M, Roth B. Management of acute inflammatory childhood stridor. Otolaryngol Head Neck Surg 1999; 121:633.
  63. Damm M, Eckel HE, Jungehülsing M, Roth B. Airway endoscopy in the interdisciplinary management of acute epiglottitis. Int J Pediatr Otorhinolaryngol 1996; 38:41.
  64. Vauthy PA, Reddy R. Acute upper airway obstruction in infants and children. Evaluation by the fiberoptic bronchoscope. Ann Otol Rhinol Laryngol 1980; 89:417.
  65. Sobol SE, Zapata S. Epiglottitis and croup. Otolaryngol Clin North Am 2008; 41:551.
  66. Carey MJ. Epiglottitis in adults. Am J Emerg Med 1996; 14:421.
  67. Ehara H. Tenderness over the hyoid bone can indicate epiglottitis in adults. J Am Board Fam Med 2006; 19:517.
  68. Madhotra D, Fenton JE, Makura ZG, et al. Airway intervention in adult supraglottitis. Ir J Med Sci 2004; 173:197.
  69. Molteni RA. Epiglottitis: incidence of extraepiglottic infection: report of 72 cases and review of the literature. Pediatrics 1976; 58:526.
  70. Ragosta KG, Orr R, Detweiler MJ. Revisiting epiglottitis: a protocol--the value of lateral neck radiographs. J Am Osteopath Assoc 1997; 97:227.
  71. Ducic Y, Hébert PC, MacLachlan L, et al. Description and evaluation of the vallecula sign: a new radiologic sign in the diagnosis of adult epiglottitis. Ann Emerg Med 1997; 30:1.
  72. Schumaker HM, Doris PE, Birnbaum G. Radiographic parameters in adult epiglottitis. Ann Emerg Med 1984; 13:588.
  73. Hung TY, Li S, Chen PS, et al. Bedside ultrasonography as a safe and effective tool to diagnose acute epiglottitis. Am J Emerg Med 2011; 29:359.e1.
  74. Werner SL, Jones RA, Emerman CL. Sonographic assessment of the epiglottis. Acad Emerg Med 2004; 11:1358.
  75. Ko DR, Chung YE, Park I, et al. Use of bedside sonography for diagnosing acute epiglottitis in the emergency department: a preliminary study. J Ultrasound Med 2012; 31:19.
  76. Stankiewicz JA, Bowes AK. Croup and epiglottitis: a radiologic study. Laryngoscope 1985; 95:1159.
  77. Hafidh MA, Sheahan P, Keogh I, Walsh RM. Acute epiglottitis in adults: a recent experience with 10 cases. J Laryngol Otol 2006; 120:310.
  78. Chan KO, Pang YT, Tan KK. Acute epiglottitis in the tropics: is it an adult disease? J Laryngol Otol 2001; 115:715.
  79. McEwan J, Giridharan W, Clarke RW, Shears P. Paediatric acute epiglottitis: not a disappearing entity. Int J Pediatr Otorhinolaryngol 2003; 67:317.
  80. Lee SS, Schwartz RH, Bahadori RS. Retropharyngeal abscess: epiglottitis of the new millennium. J Pediatr 2001; 138:435.
  81. Cherry JD. Clinical practice. Croup. N Engl J Med 2008; 358:384.
  82. Bjornson CL, Johnson DW. Croup. Lancet 2008; 371:329.
  83. Yen K, Flanary V, Estel C, et al. Traumatic epiglottitis. Pediatr Emerg Care 2003; 19:27.
  84. Kabbani M, Goodwin SR. Traumatic epiglottis following blind finger sweep to remove a pharyngeal foreign body. Clin Pediatr (Phila) 1995; 34:495.
  85. Li SF, Siegel B, Hidalgo I, et al. Laryngopyocoele: an unusual cause of a sore throat. Am J Emerg Med 2012; 30:1655.e1.