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Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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When epiglottitis strikes, it usually occurs quickly but may range from just a few hours to a few days. The most common symptoms include sore throat, muffling or changes in the voice, difficulty speaking, fever, difficulty swallowing, fast heart rate, and difficulty in breathing. A person with acute epiglottitis usually looks very ill.

Epiglottitis symptoms include:

• trouble breathing (respiratory distress),
• drooling,
• leaning forward to breathe,
• taking rapid shallow breaths,
• "pulling in" of muscles in the neck or between the ribs with breathing (retractions),
• high-pitched whistling sound when breathing (stridor), and
• trouble speaking.

Children may sit in a "sniffing position" with the body leaning forward and the head and nose tilted forward and upward as though they are sniffing a good smelling pie.

People with epiglottitis may appear restless and breathing with their neck, chest wall, and upper belly muscles. While they may be taking in less air with each breath, they will still manifest the high-pitched whistling sound, called inspiratory stridor.

Typically, a child who comes to the hospital with epiglottitis has a history of fever, difficulty talking, irritability, and problems swallowing for several hours. The child often sits forward and drools.

In infants younger than one year, signs and symptoms such as fever, drooling, and upright posturing may all be absent. The infant may have a cough and a history of an upper respiratory infection. It is very difficult to know if an infant has epiglottitis.

In contrast, adolescents and adults have a more generally ill appearance with sore throat as the main complaint along with fever, difficulty breathing, drooling, and stridor (noise with breathing). Doctors have characterized adult epiglottitis into 3 categories:

• Category 1: Severe respiratory distress with imminent or actual respiratory arrest. People typically report a brief history with a rapid illness that quickly becomes dangerous.
• Category 2: Moderate-to-severe clinical symptoms and signs of considerable risk for potential airway blockage. Symptoms include sore throat, inability to swallow, difficulty in lying flat, muffled "hot potato" voice (speaking as if they have a mouthful of hot potato), stridor, and the use of accessory respiratory muscles with breathing.
• Category 3: Mild-to-moderate illness without signs of potential airway blockage. These people often have a history of illness that has been occurring for days with complaints of sore throat and pain upon swallowing.

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