Sarah Silverman Survives Life-Threatening Infection

Actress/comedienne Sarah Silverman took to Facebook yesterday to explain why she hadn’t been seen lately.

Seems she almost died from a life-threatening infection called epiglottitis.

Hi. This is me telling everyone in my life at once why I haven’t been around. This will not interest everyone so feel free to disregard.
I was in the ICU all of last week and I am insanely lucky to be alive. Don’t even know why I went to the doctor, it was just a sore throat. But I had a freak case of epiglottitis.

Silverman had to be intubated for several days, and was in the ICU at Cedar Sinai for five days. She had to be heavily drugged for the pain, and restrained with her hands tied down so she wouldn’t tear out the breathing tube.

I couldn’t speak for a while and I don’t remember a lot of my “lucid” time, but Amy (the Zvi) told me I stopped a nurse – like it was an emergency – furiously wrote down a note and gave it to her. When she looked at it, it just said, “Do you live with your mother?” next to a drawing of a penis.
Also, when I first woke up and the breathing tube came out, I still couldn’t talk and they gave me a board of letters to communicate. My loved ones stood there, so curious what was going to be the first thing I had to say. They followed my finger, rapt, as I pointed from letter to letter until I finally spelled out, “Did you see ‘Hello My Name is Doris.'”

Silverman thanked the doctors and nurses who took care of her, her boyfriend actor Michael Sheen, and her family and friends who stayed by her side during her time at the hospital.

What is epiglottitis?

Epiglottitis is inflammation and swelling of the epiglottis. In most cases, it’s caused by infection.

airway anatomyThe epiglottis is a flap of elastic cartilage that sits beneath the tongue at the back of the throat.  It stands open during breathing, allowing air into the larynx. During swallowing, it closes to prevent aspiration, forcing the swallowed liquids or food to go down the esophagus instead. It is thus the valve that diverts passage to either the trachea or the esophagus.

Swelling of the epiglottis is usually caused by the bacteria Haemophilus influenzae (H. influenzae). It may also be due to other bacteria, such as Streptococcus or viruses that can cause upper respiratory infections.

Epiglottitis has become very uncommon since the introduction of  the H. influenzae type B (Hib) vaccine as a routine childhood immunization. The disease was once most often seen in children ages 2 through 6. In rare cases, epiglottitis can occur in adults.

Symptoms of epiglottitis

The symptoms of epiglottitis usually develop quickly and get rapidly worse, although they can develop over a few days in older children and adults. Symptoms include:

  • a severe sore throat
  • difficulty and pain when swallowing
  • difficulty breathing, which may improve when leaning forwards
  • breathing that sounds abnormal and high-pitched (stridor)
  • a high temperature (fever) of 100.4ºF (38C º) or above
  • irritability and restlessness
  • muffled or hoarse voice
  • drooling

The main symptoms of epiglottitis in young children are breathing difficulties, stridor and a hoarse voice. In contrast, adults and older children have a more generally ill appearance with sore throat as the main complaint along with fever, difficulty breathing, drooling, and stridor (noise with breathing).

Doctors have characterized adult epiglottitis into 3 categories:

  • Category 1: Severe respiratory distress with imminent or actual respiratory arrest. People typically report a brief history with a rapid illness that quickly becomes dangerous.
  • Category 2: Moderate-to-severe clinical symptoms and signs of considerable risk for potential airway blockage. Symptoms include sore throat, inability to swallow, difficulty in lying flat, muffled “hot potato” voice (speaking as if they have a mouthful of hot potato), stridor, and the use of accessory respiratory muscles with breathing.
  • Category 3: Mild-to-moderate illness without signs of potential airway blockage. These people often have a history of illness that has been occurring for days with complaints of sore throat and pain upon swallowing.

NOTE: Epiglottitis is considered a medical emergency and should be evaluated by a physician in a hospital as soon as possible.

How is epiglottitis diagnosed?

Epiglottitis_endoscopyThe doctor may order X-rays or simply look at the epiglottis and the windpipe by laryngoscopy. The epiglottis will be seen as red and swollen. Laryngoscopy is a procedure best performed in an operating room: touching the epiglottis can cause increased swelling or spasm of the muscles around it, leading to obstruction of the airway.

A lateral (side view) x-ray of the neck of a patient with epiglottitis will show what is called “the thumbprint sign”-a swollen, enlarged epiglottis.

Normal xray vs. patient with epiglottitis

Normal xray vs. patient with ” thumb sign” of epiglottitis

What is the treatment?

Successful treatment requires early recognition of the disease. A high index of suspicion is needed, especially in adults. Up to 2/3 of adult patients are originally misdiagnosed. All patients will be admitted to the hospital (often to the intensive care unit). They will receive IV antibiotics to fight the infection and most will be taken to the operating room to have the epiglottis visualized. Intubation (placement of a plastic breathing tube) into the trachea will protect the airway from obstruction of swelling. The tube may stay in place for several days, until the swelling has abated.


Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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