Comedian Sarah Silverman says she is “lucky to be alive” after a life-threatening case of epiglottitis last week. After visiting the doctor for a sore throat, Silverman said she ended up in the ICU for at least five days, drugged and restrained.
Her terrifying ordeal illustrates how a seemingly run-of-the-mill sore throat can be potentially lethal. What is this unusual “freak” condition, as Silverman called it, and why have many of us never heard of it?
What is epiglottitis?
“It’s a bacterial infection of the upper part of the larynx,” explained Dr. Michael G. Stewart, chairman of otolaryngology at Weill Cornell Medical College. “It’s a very serious infectious condition of the upper airway in a very bad location. The same amount of swelling on your tongue would be painful, but it wouldn’t be life-threatening. But because it’s right above the vocal cords and trachea, it can be life-threatening.”
The epiglottis is a small piece of cartilage that covers your windpipe. If you’ve ever swallowed food or water “down the wrong pipe,” it’s because your epiglottis didn’t close all the way. Epiglottitis occurs when that flap of cartilage swells, blocking airflow to your lungs.
“It’s more properly called supraglottitis,” Stewart clarified, “because almost invariably it involves all the structures above the vocal cords, the epiglottis being the largest one.”
Your epiglottis might also swell due to burning with hot liquid or traumatic injury to your throat. Epiglottitis can cause serious complications such as respiratory failure and sepsis. But if you haven’t heard of epiglottitis before, that may be because the condition is quite rare and under-recognized.
What causes epiglottitis?
The most common cause of epiglottitis is infection with Haemophilus influenzae type b, known as Hib. This bacteria can also cause pneumonia and meningitis. Hib can be contracted by inhaling germs when infected individuals cough, sneeze or blow their nose. Thankfully, most infants receive Hib vaccinations, which has made epiglottitis rare.
Various bacterial infections like Streptococcus A, B or C ― the same bacteria that cause strep throat ― and the viruses that cause shingles and chicken pox can also lead to epiglottitis, along with throat injuries or burns.
What are the symptoms?
Epiglottitis is no average sore throat. “Epiglottitis is severe throat pain ― so severe you can’t even swallow your own saliva, so severe that it feels like you might be having difficulty breathing,” said Stewart. “Patients will typically be sitting literally drooling, often because it’s so painful to actually swallow.”
One clue you may have epiglottitis is an abnormal sound when inhaling. This noise is called “stridor,” and it is a high-pitched, almost musical breathing sound that occurs when the airway is blocked. Stridor may also point to other conditions, such as allergic reaction or croup, but can be a sign of an emergency.
Children can develop these symptoms within a matter of hours, while in adults they tend to develop over a few days. If you or someone you know suddenly experiences difficulty breathing or swallowing, seek emergency medical help immediately.
How likely am I to develop epiglottitis?
Not very. A 2010 study showed that incidence of epiglottitis in the U.S. dropped from approximately 4,587 cases in 1998 to 3,772 cases in 2006. In a country of over 320 million people, these numbers indicate the ailment is extremely rare.
In other words, people with every day sore throats should not start rushing to the ER. “This is quite rare,” Stewart said, “and sore throats are quite common.”
The study did show that the mean age of admitted patients with epiglottitis is 44.94 years ― almost exactly Sarah Silverman’s age ― with less frequent admission of children and teens.
“Adults come in with it and people don’t think about it because it’s not as frequent as it used to be, and it’s presenting in people that the textbooks don’t say it presents in,” said Stewart.
How can I prevent epiglottitis?
How do we put this lightly? Get the Hib vaccine. While epiglottitis is just one complication from infection with Hib, the bacterium can also cause other potentially fatal diseases including bacterial meningitis and pneumonia. The vaccine is not usually given to adults and children over 5, so make sure your infants are vaccinated. Adults should ask their doctor about the vaccine if their immune system is weakened by a chronic disease, transplant, or chemotherapy.
Before the Hib vaccine, Hib infection was the leading cause of bacterial meningitis in children under 5 in the United States. Approximately 20,000 children contracted Hib diseases each year, and about 3-6 percent of them died, according to the Centers for Disease Control and Prevention. Since the Hib vaccine became available, the number of cases of Hib disease has decreased more than 99 percent.
Standard germ precautions also apply to epiglottitis prevention: Always wash your hands, and try not to share personal items.
This post has been updated to include comment from Dr. Michael G. Stewart.