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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): Management".)


Epiglottitis describes 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.

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Literature review current through: Sep 2017. | This topic last updated: May 03, 2017.
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