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 difficulties in breathing.
Fever is usually high but may be low at 100.1° F in adults or even slightly lower at 99° F in cases of thermal epiglottitis.
- Signs of respiratory distress, or trouble breathing, are seen with epiglottitis. Signs include drooling, leaning forward to breathe, taking rapid shallow breaths, "pulling in" of muscles in the neck or between the ribs with breathing, a high-pitched whistling sound when breathing, and trouble speaking. Someone with acute epiglottitis usually looks very ill.
- Children may sit in a "sniffing position" with the body leaning forward and the head and nose tilted forward and upward.
- 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 1 year of age, 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. Thus it is very difficult to know if an infant has epiglottitis.
- In contrast, adolescents and adults have more recognizable symptoms with sore throat being 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. Blood cultures, which are tests that check for bacteria in the blood, are often positive for Hib.
- Category 2: Moderate-to-severe clinical symptoms and signs of considerable risk for potential airway blockage. Symptoms and signs usually 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.
When to Seek Medical Care
The following combination of signs and symptoms should lead you to go directly to a hospital's emergency department:
- Sore throat
- Muffled voice
- Swallowing problems
- Fast heartbeat
- Respiratory distress characterized by drooling, shortness of breath, rapid shallow breathing, very ill-looking appearance, upright posturing with tendency to lean forward, and stridor (high-pitched sound when breathing in)