About This Page
This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
The Bottom Line
- Life-threatening: acute epiglottic inflammation → airway obstruction
- Acute sore throat, dysphagia, drooling, hot potato voice, stridor, tripod position, high fever
- DO NOT examine throat — risk of precipitating complete obstruction
- Call senior anaesthetist + ENT. Keep patient calm and upright
- After airway secured: IV ceftriaxone + dexamethasone
- Rare in children since Hib vaccine (1992) — now more common in ADULTS
Overview
Epiglottitis is acute inflammation of the epiglottis and supraglottic structures causing life-threatening airway obstruction. Since Hib vaccination in 1992, childhood epiglottitis is very rare and the condition now more commonly affects adults. In adults, Streptococcus, Staphylococcus, and Haemophilus are causative. Can progress from sore throat to complete obstruction within hours.
Epidemiology
Childhood incidence dropped >99% since Hib vaccine. Adult incidence ~1–4 per 100,000/year, peak 40–60 years, more common in males. Mortality ~1% with prompt management.
Clinical Features
Symptoms
Acute severe sore throat — rapidly progressive
Drooling, unable to swallow
Hot potato voice (NOT hoarse — cords below epiglottis)
High fever, toxic appearance
Stridor — ominous late sign
Signs
Tripod position: sitting upright, leaning forward, chin extended, mouth open
Inspiratory stridor
Drooling
Relatively normal oropharynx (inflammation is supraglottic)
Investigations
First-line
Clinical diagnosis — DO NOT delayDo NOT examine throat, use tongue depressor, or perform X-ray if airway compromised
Second-line
Lateral neck X-rayIf stable and diagnosis uncertain — "thumb sign" (swollen epiglottis)
Flexible nasendoscopyBy experienced ENT in controlled setting — cherry-red swollen epiglottis
Specialist
Blood culturesAfter airway secured
Management
ATLS/Advanced Airway Guidelines1
AIRWAY FIRST
- Call senior anaesthetist + ENT immediately
- Keep calm, position of comfort (sitting)
- DO NOT examine throat, DO NOT lie down, DO NOT cannulate until airway secured
- High-flow humidified oxygen if tolerated
- Prepare for intubation in theatre + surgical airway backup
2
Airway management
- Children: gas induction → intubation. If fails → rigid bronchoscopy/tracheostomy
- Adults: awake fibreoptic intubation or gas induction
- ICU admission. Extubation after 24–48 h when swelling resolves
3
Medical (after airway)
- IV ceftriaxone 2 g OD
- IV dexamethasone 0.6 mg/kg (max 10 mg)
- IV fluids
- Total antibiotic course 7–10 days
4
Prevention
- Hib vaccine: UK schedule at 2, 3, 4 months + booster 12–13 months
Complications
- Complete airway obstruction and death
- Epiglottic abscess
- Sepsis: Blood culture positive >50%
UKMLA Exam Tips
- 1Epiglottitis vs croup: epiglottitis = acute, high fever, drooling, no cough, toxic. Croup = gradual, barking cough, low fever, preceded by coryza
- 2DO NOT examine throat — single most tested point
- 3Thumb sign on lateral X-ray = epiglottitis. Steeple sign = croup
- 4Now more common in ADULTS than children (Hib vaccine)
- 5Hot potato voice but NOT hoarse — epiglottis is above vocal cords
- 6After airway: IV ceftriaxone + dexamethasone
practicetest your knowledge on epiglottitisApply what you've learnt with UKMLA-style questions from the iatroX Q-Bank — ent and beyond.
open q-bank