Symptoms of Epiglottitis
Epiglottitis presents with sudden onset of severe sore throat, painful swallowing (odynophagia), and drooling, with potential for rapid progression to life-threatening airway obstruction within hours. 1
Cardinal Symptoms
The classic presentation includes:
- Severe sore throat with sudden onset - present in virtually all cases and often disproportionate to visible pharyngeal findings 1, 2
- Odynophagia (painful swallowing) - occurs in 100% of adult cases 2
- Drooling or inability to swallow secretions - present in 83% of cases and indicates severe disease requiring emergency airway intervention 2, 3
- Fever - elevated temperature (>37.2°C) occurs in approximately 75% of patients 2
Additional Common Symptoms
- Dyspnea (difficulty breathing) - present in 58% of cases 2
- Hoarse voice or muffled voice quality - occurs in 50% of cases 4, 2
- Sore throat - reported in 67% of patients 2
Critical Warning Signs of Airway Obstruction
- Inspiratory stridor - surprisingly present in only 42% of cases, so its absence does not exclude epiglottitis 2
- Drooling - this symptom specifically indicates need for immediate airway intervention 3
- Dyspnea with anxiety or fear - indicates impending airway compromise requiring emergency referral 4
- Tachycardia (>100 bpm) - present in 50% of cases 2
Important Clinical Pitfalls
A normal oropharyngeal examination does not exclude epiglottitis - 44% of confirmed cases had normal-appearing throat on routine examination, making direct visualization by laryngoscopy essential when epiglottitis is suspected 2. The discrepancy between severity of symptoms and minimal pharyngeal findings is a key diagnostic clue 4.
Time-Critical Considerations
Patients presenting within 8 hours of symptom onset almost universally require airway intervention, while those presenting after 8 hours typically have a more benign course 3. This underscores the importance of recognizing symptoms early and referring immediately when suspected.
Adult mortality remains approximately 7% despite treatment, compared to 1% in pediatric populations with aggressive management 1, 5, making prompt recognition and intensive care monitoring essential for all suspected cases.