History and exam

Key diagnostic factors

common

presence of risk factors

Risk factors include non-vaccination with Hib vaccine, immunocompromise, or middle age.

non-vaccination with Hib vaccine

Vaccination does not preclude the possibility of epiglottitis or even the possibility of epiglottitis from Haemophilus influenzae. However, since introduction of the vaccine, the incidence has reduced by about 95% in the US.[17]

sore throat

Often progresses rapidly. In adults, 88% complain of sore throat.[20]

dysphagia

In adults, 83% complain of pain with swallowing.[20]

difficulty in controlling secretions

Pain with swallowing may limit ability to control secretions.

toxic appearance

Especially in children.

acute distress

Especially in children.

fever

Especially in children but also present in about 38% of adult patients.[20]​ Rapid (less than 12 to 24 hours) onset.[23]

tripod position

A natural response in children that optimises airflow through a narrowed laryngeal inlet.[21] Tripod positioning is where the child postures the neck and head anteriorly and places his/her hands on his/her knees. Anterior displacement of the mandible and neck allows the child to breathe much more easily, as the hyoid and epiglottis are also moved anteriorly, which opens up the effective airway space for breathing.

difficulty breathing

Present in children and adults. In adult patients, 34% have signs of respiratory difficulty.[20]

Other diagnostic factors

common

decreased oral intake

Decreased oral intake may be seen in children during illness.

muffled voice

Also described as a 'hot potato' voice. Present in children and adults. In adult patients, 25% have a muffled voice.[20]

stridor

Stridor suggests upper airway narrowing and impending closure.

Stridor
Stridor

Auscultation sounds: Stridor

​

irritability

Irritability is common in children who are ill.

uncommon

drooling

Common in children, but only 7% of adults present with drooling.[20]

Risk factors

strong

non-vaccination with Hib vaccine

Vaccination with Haemophilus influenzae type B (Hib) conjugated vaccine has reduced the incidence by about 95% in the US.[17] Vaccine failures have also been documented, and genetic polymorphisms have been strongly linked in these patients.[18]

immunocompromise

Patients with non-competent immune systems may manifest in varying ways and with differing severity compared with people with competent immune systems. Immune-suppression may dispose patients to necrotising epiglottitis, a rare and more aggressive form of the disease.[19]

middle age

One US study, which involved 33,549 adult patients from 2007 to 2014, found that the overall mean age of adult patients with epiglottitis is 49 years.[9]

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