Pain when swallowing, known medically as odynophagia, can be a sign of inflammation or swelling in the throat, and when this pain is specifically located near the base of the tongue, the epiglottis may be the source. The epiglottis is a small, leaf-shaped flap of cartilage situated behind the tongue, at the top of the larynx or voice box. Its sole function is to act as a protective barrier. When breathing, the epiglottis remains open to allow air into the lungs, but during the act of swallowing, it closes swiftly to cover the windpipe (trachea). This closing action ensures that food and liquid are properly directed down the esophagus and prevents them from entering the airway, which would cause choking.
Understanding Acute Epiglottitis
The most serious and potentially life-threatening cause of epiglottis pain is acute epiglottitis, a rapid inflammation and swelling of the epiglottis and surrounding supraglottic structures. This condition is classified as a medical emergency because the swelling can quickly block the airway, leading to respiratory arrest.
Historically, the bacterium Haemophilus influenzae type b (Hib) was the primary cause of acute epiglottitis, predominantly affecting young children. However, the widespread adoption of the Hib vaccine has reduced cases in children and shifted the incidence, making it more common in adults. Despite the vaccine’s success, Hib still accounts for adult cases, but other bacterial agents are now frequently implicated.
In adults, the infectious causes are more diverse, commonly including Streptococcus pneumoniae (pneumococcus), Group A, B, or C Streptococci, and Staphylococcus aureus. These bacteria infect the tissue, leading to a rapid inflammatory response that causes the epiglottis to swell to several times its normal size. This swelling, located directly above the opening to the windpipe, creates severe difficulty and pain when swallowing, as the act pushes the inflamed tissue over the airway opening.
The progression of the disease in adults is often more insidious than in children, sometimes developing over several days rather than hours, which can mask the severity of the infection. Risk factors for developing bacterial epiglottitis in adults include diabetes mellitus, a weakened immune system, and alcohol abuse. The underlying danger remains the same: the potential for swift and complete airway closure.
Non-Infectious Causes of Epiglottis Pain
Inflammation in this area can stem from a variety of non-infectious sources. These causes are generally less likely to cause the rapid, massive swelling seen in acute bacterial epiglottitis, but they can still result in significant pain when swallowing.
Viral infections are a common cause of inflammation in the upper respiratory tract, and some, like herpes simplex virus or varicella-zoster virus, can contribute to epiglottis swelling. Although a virus alone may not cause the most severe form of epiglottitis, a prior viral infection can weaken the area and allow for a subsequent bacterial superinfection to take hold.
Direct physical or chemical trauma to the area can also lead to pain and inflammation. Thermal injury, such as swallowing extremely hot liquids or foods, can cause burns and swelling of the epiglottis.
Chemical irritation from severe acid reflux, where stomach acid reaches the throat (laryngopharyngeal reflux or LPR), or exposure to caustic substances can injure the tissue. Direct trauma, such as a blow to the throat, injury from intubation procedures, or the ingestion of a foreign object like a fishbone, may also cause localized pain and swelling.
Critical Symptoms and When to Seek Emergency Care
The presence of pain when swallowing, especially if it is severe and rapidly worsening, should raise immediate concern for epiglottitis. This necessitates urgent medical evaluation due to the potential for rapid airway obstruction.
A set of symptoms often used to describe impending airway compromise are dysphagia (difficulty swallowing), drooling (due to the inability to swallow saliva), and distress (difficulty breathing). The pain is typically disproportionately severe compared to a common sore throat, and the voice may sound muffled or like a “hot potato” is in the mouth. If a high-pitched, harsh sound is heard when breathing in, known as stridor, it signals that the airway is already significantly narrowed and requires immediate intervention.
A patient, particularly a child, may instinctively adopt the “tripod position,” sitting upright, leaning forward, and extending the neck to maximize airflow. If any of these severe symptoms are present, emergency medical services (such as 911) should be contacted immediately. Crucially, if acute epiglottitis is suspected, the patient should not be laid flat, nor should a tongue depressor be used to examine the throat, as this manipulation can trigger a complete closure of the already compromised airway.
Upon arrival at a medical facility, the primary concern is securing the airway before any diagnostic procedures. Diagnosis is typically confirmed by specialized imaging, like a lateral neck X-ray which may show the swollen tissue as the “thumb sign,” or by a flexible fiberoptic laryngoscopy. This examination visualizes the inflamed epiglottis and is generally performed in a controlled setting, such as an operating room or intensive care unit, where emergency airway equipment is immediately available.
Medical Management and Recovery
Ensuring a stable airway is the primary aspect of managing acute epiglottitis. For patients showing signs of respiratory distress or significant swelling, this often means endotracheal intubation, where a breathing tube is inserted into the trachea to bypass the swollen epiglottis. This procedure is conducted under highly controlled conditions, typically in an intensive care unit, and the tube remains in place until the swelling subsides, often for a few days.
Once the airway is secured, or if the patient’s condition is stable enough to avoid intubation, the focus shifts to treating the underlying cause, which in most cases is a bacterial infection. Intravenous antibiotics are administered immediately, often a broad-spectrum agent like a third-generation cephalosporin, before the specific causative organism is identified from blood or epiglottic cultures. The antibiotic regimen usually lasts for seven to ten days, with a possible transition to oral medication once the patient shows improvement.
For all causes of epiglottis inflammation, supportive care remains a priority, including intravenous fluids to maintain hydration, especially since swallowing is painful or impossible. Corticosteroids may also be administered intravenously to help reduce the inflammatory swelling of the epiglottis. For non-infectious causes, such as chemical or thermal injury, treatment focuses on pain relief, reducing inflammation, and addressing the primary issue, like using acid-suppressing medication for severe reflux.