Wondering what Sarah Silverman has been up to lately? It turns out the comedian had a near-death experience, spending last week in the ICU with epiglottitis, a rare but deadly condition. Thankfully, she survived, but it left us with some serious questions. Namely, what's an epiglottis and how was a healthy, adult woman nearly killed by hers?
The epiglottis is a small, fleshy flap in your throat that acts like a "trap door" covering the opening to your trachea, or windpipe, to prevent food from going down it when you eat. Breathing? The epiglottis is up. Eating or drinking? It's down. When it's working well, you don't even feel it doing its very important job, but it can get infected. And when it does, it can quickly become a life-threatening condition.
"Epiglottitis is caused by an infection, usually by a bacteria called Haemophilus influenza type B, which causes the thin flap to become round and swollen, like a red cherry, effectively blocking the windpipe," explains Robert Hamilton, M.D., pediatrician at Providence Saint John's Health Center in Santa Monica.
Wait, why are we talking to a pediatrician? Because the vast majority of cases affect children due to their smaller trachea and higher susceptibility to infection—in pre-antibiotic years, it was a common killer of little ones—but thanks to modern medicine, it's hardly ever seen anymore, he says.
"There's a HiB vaccine that protects against the bacteria responsible for most cases of epiglottitis, but most adults haven't received it," Hamilton says. (The vaccine, which also protects against meningitis and pneumonia, did not become widely available until 1987, meaning people born before that date, like Silverman, either had to get the illness as children to acquire their own immunity or remained susceptible to the disease.)
This rarity, combined with its common symptoms, make it a tricky diagnosis, Hamilton says, adding that Silverman was incredibly lucky her doctor recognized it. "Patients generally present with a sore throat and a fever. What illness does that sound like? Pretty much all of them," he says.
But as the illness quickly progresses, patients demonstrate "air hunger," meaning their oxygen levels drop as they work harder to breathe. Perhaps the most commonly recognized symptom is tipping the head back and up to try and open the airway more. This may lead the doctor to order tests to evaluate the epiglottis or to simply look down the patient's throat—if it's extremely swollen, it can be seen just with a flashlight.
At this point, it's a true medical emergency and requires either a tracheotomy (a procedure where a small tube is placed in the front of the person's neck) or intubation (where a tube is put down the throat) to immediately open the airway, Hamilton says. The patient is then treated with antibiotics and kept on the breathing tube until the infection resolves and the swelling subsides, which is why Silverman was kept in the ICU for a week.
While she says the experience was incredibly traumatic, there were some funny moments. "I stopped a nurse - like it was an emergency - furiously wrote down a note and gave it to her," Silverman wrote on Facebook. "When she looked at it, it just said, 'Do you live with your mother?' next to a drawing of a penis."
After recovery, patients like Silverman are now immune to the bacteria, Hamilton explains. But if you're concerned about your epiglottis attacking you out of the blue one day, there are two things you can do to prevent it. First, most adults had a lesser version of the infection as kids and are mostly likely immune to it. But it you're worried, you can get the HiB vaccine now. The best thing you can do, though, is to practice good hygiene. Wash your hands with soap and use antibiotic medications only when truly needed, says Hamilton. (Psst...Here's How to Tell If You *Actually* Need Antibiotics.)