Acute airway obstruction (epiglottitis): a case

The presentation

Imagine a person — a child or an adult — who becomes unwell very quickly with a high fever and a severe sore throat, far worse than an ordinary one. Within hours they are struggling to swallow, drooling because it hurts too much to swallow their own saliva, and their voice sounds muffled or hushed. They may sit very still, leaning forward with the chin pushed out and mouth open, because this is the only way they can keep their airway open, and they look frightened and seriously ill. Their breathing may become noisy, with a harsh sound when breathing in. This picture — rapid onset, high fever, severe sore throat, drooling, a muffled voice and difficulty breathing — is very different from a common cold or mild sore throat, and it should ring loud alarm bells.

Why epiglottitis is so dangerous

The epiglottis is a small flap of tissue at the base of the tongue that guards the entrance to the windpipe, folding down to stop food and drink going the wrong way when you swallow. If it becomes infected and inflamed, it can swell rapidly and, because it sits right at the top of the airway, this swelling can narrow or completely block the passage that air must travel through to reach the lungs. Unlike many throat infections that are uncomfortable but harmless, epiglottitis can shut off breathing within a short time. The swelling can worsen quickly and unpredictably, and anything that upsets or frightens the person — including examining the throat — can make it suddenly worse. This is why epiglottitis is treated as a true airway emergency, where every minute counts and calm, urgent action is vital.

When to call 999

Call 999 immediately if someone becomes rapidly unwell with a high fever and severe sore throat and then develops difficulty breathing, difficulty or pain on swallowing, drooling, a muffled or hushed voice, or noisy breathing, especially if they are sitting still and leaning forward to breathe. Tell the call handler that you are worried about the person's breathing and throat. Crucially, keep them as calm and still as possible and do not try to look inside their throat, lie them down, or put anything, including a spoon or your fingers, into their mouth, as this can trigger a sudden, complete blockage. Let them sit in whatever position they find most comfortable, usually upright and leaning forward, stay with them, reassure them gently, and wait for the emergency team.

How it is treated

Epiglottitis is managed as an emergency by paramedics and hospital specialists, and the first priority is always to keep the airway open. This is done by experienced clinicians in a controlled setting, and if needed they can secure the airway so the person can breathe safely. Once the airway is protected, the infection causing the swelling is treated and the person is supported and monitored closely, usually in a high-dependency or intensive care area until the swelling settles. Because the danger is the airway closing suddenly, all of this must happen calmly and quickly with the right expertise and equipment to hand — none of it can be done at home. The most valuable thing a bystander can do is recognise the emergency, call 999, and keep the person calm and undisturbed until help arrives.

The safe pathway

The practical rule is that a severe, rapidly worsening sore throat with fever, drooling, a muffled voice or any difficulty breathing is an emergency, whatever the exact cause. You do not need to diagnose epiglottitis — the response is the same: call 999 straight away, keep the person calm and upright, and do not examine or interfere with their throat. Vaccination has made one common cause of epiglottitis much rarer in children, which is a reminder of why routine immunisations matter, but the condition can still occur in both children and adults. Because the airway can close quickly and unpredictably, staying calm, avoiding anything that distresses the person, and getting expert help fast are what keep them safe. Recognising this alarming pattern early is potentially life-saving.