PassFinals
ENT

Epiglottitis

Epiglottitis or supraglottitis is acute swelling around the laryngeal inlet that can obstruct the airway rapidly; keep the person calm and upright, avoid throat manipulation, call senior anaesthetic and ENT help and secure the airway before tests or routine treatment.

In a nutshell

Epiglottitis/supraglottitis is a potentially fatal upper-airway emergency in children and adults. Suspect it with severe throat pain or odynophagia, drooling, muffled voice, stridor and an upright or tripod posture. Keep the patient calm and upright, do not examine the throat or delay for bloods/X-ray/CT, call senior anaesthetic and ENT help and secure the airway in a controlled setting. Once safe, give IV antibiotics and apply UKHSA Hib public-health measures only if invasive Hib is confirmed.

Classic presentation

A febrile child sits upright, drooling, toxic and quiet, with a muffled voice, soft stridor and no barking cough; an adult may instead have severe odynophagia with a relatively normal oropharynx.

Key points

  • Treat suspected epiglottitis as an airway emergency, not an ordinary sore throat.
  • Keep the patient upright and calm; do not use a tongue depressor, force the mouth open, lie them flat or delay for investigations.
  • Call senior anaesthesia and ENT early; airway control occurs in a controlled environment with rescue surgical-airway capability.
  • After airway safety, give IV antibiotics according to local microbiology guidance and BNF.
  • Confirmed invasive Hib requires UKHSA notification, index-case/household chemoprophylaxis and immunisation review; not every case is Hib.
  • Hib vaccination makes childhood Hib rare, but adult supraglottitis remains a current patient-safety risk.

First-line investigation

None before airway stabilisation; after specialist airway control, perform controlled laryngoscopy/nasendoscopy and safe cultures, with imaging only if it will not delay care.

Management

Protect the airway

  • Keep the patient upright and calm, avoid throat manipulation and call senior anaesthetic, ENT, paediatric/critical-care and nursing support immediately.2,1,3

Do not delay for tests

  • Do not force oral examination, take bloods or send an airway-compromised child for X-ray/CT before specialist airway planning; bring equipment and expertise to the patient.3,5

Secure and treat

  • Secure the airway in a controlled environment when indicated, then give IV ceftriaxone/cefotaxime or the local microbiology-recommended alternative and obtain safe cultures.2,4,8

Critical care and infection control

  • Admit for monitored airway and sepsis care, use appropriate isolation/PPE and involve microbiology; steroids or nebulised adrenaline never replace definitive airway assessment.4,2

Apply Hib public-health action

  • If invasive Hib is confirmed, notify public health and arrange current UKHSA chemoprophylaxis and immunisation review for the index case and relevant contacts.6,7,8

Observe until safe

  • Continue monitored care until supraglottic swelling and respiratory risk resolve, step down antibiotics with microbiology advice and provide deterioration safety-netting.1,4,6

Exam traps

  • Do not examine the throat with a tongue depressor: manipulation can precipitate complete obstruction.
  • Drooling and a muffled voice with no barking cough favour epiglottitis over croup.
  • Quiet or soft stridor can mean critically reduced airflow and impending obstruction.
  • A normal-looking adult oropharynx does not exclude supraglottitis when odynophagia is severe.
  • Do not give rifampicin prophylaxis to every epiglottitis patient; use the UKHSA pathway for confirmed invasive Hib.

Illustrations

Thumbprint sign on lateral neck X-rayA lateral soft-tissue neck radiograph showing a swollen epiglottis producing the thumbprint sign, contrasted with the normal narrow epiglottic shadow.Med Chaos, Wikimedia Commons · CC0

Key sources

  1. NHS: Epiglottitis (NHS emergency advice, symptoms, upright positioning, hospital airway treatment and antibiotic/testing overview; page accessed 4 August 2026.)
  2. NHS England: Diagnosis and management of supraglottitis (Current NHS patient-safety guidance highlighting adult supraglottitis recognition, emergency airway risk, specialist environment and ENTUK adult severe-sore-throat guidance; accessed 4 August 2026.)
  3. NHS Borders: Epiglottitis (paediatric) (Current NHS Borders paediatric airway guidance: do not examine the mouth, take bloods or image before airway stabilisation; call senior anaesthesia, paediatrics and ENT; next review 1 April 2028.)Updated 1 Apr 2025
  4. NHS Lothian: Epiglottitis antimicrobial prescribing guidance (Current local antimicrobial pathway covering early ENT involvement, safe cultures, IV antimicrobial options, isolation/PPE and microbiology review; accessed 4 August 2026.)
  5. NHS Greater Glasgow and Clyde: Acute sore throat and upper-airway emergency guidance (Current paediatric emergency guidance distinguishing epiglottitis/bacterial tracheitis from croup and advising no throat examination, venepuncture or lateral neck X-ray when airway risk is present; accessed 4 August 2026.)
  6. UKHSA Green Book chapter 16: Haemophilus influenzae type b (Current UKHSA immunisation and invasive-Hib guidance; page last updated 17 March 2026, including current epidemiology, vaccination and public-health actions.)Updated 17 Mar 2026
  7. UKHSA: Revised recommendations for prevention of secondary Haemophilus influenzae type b disease (Current UKHSA recommendations for rifampicin chemoprophylaxis, index cases, household contacts and immunisation after confirmed invasive Hib disease; accessed 4 August 2026.)
  8. British National Formulary (BNF) (Current UK prescribing information for ceftriaxone, cefotaxime, rifampicin and other antimicrobial/adjunctive medicines; check age, weight, allergy, renal/hepatic function, interactions, route and local microbiology advice at prescribing; accessed 4 August 2026.)
  9. NICE NG84: Sore throat (acute): antimicrobial prescribing (NICE strategy for ordinary acute sore throat and hospital referral for severe complications; not a substitute for the airway pathway in suspected epiglottitis; accessed 4 August 2026.)

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.