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Sir.—With regard to the article by Mauro et al on visualization in possible acute epiglottitis, I have the following comments.
First, a key point is that four of six cases of epiglottitis were correctly identified clinically, but two cases, presumably milder or of shorter duration, were incorrectly clinically classified.
My own preference in the first four cases would be to perform an examination in the operating room, but I see no inherent reason why a good examination could not be done in the emergency department with an anesthesiologist present. The major fault I find is with fools who waste valuable time on lateral neck films (the radiology department, as we all know, is absolutely the worst place in which a respiratory emergency could occur).
As for the two clinically misclassified cases, I have always made it a point to try to visualize the epiglottis in children with laryngotracheobronchitis and a
GOLDENRING JM. Oropharyngeal Examination for Suspected Epiglottitis. Am J Dis Child. 1988;142(12):1263-1264. doi:10.1001/archpedi.1988.02150120017008