December 1988

Oropharyngeal Examination for Suspected Epiglottitis

Author Affiliations

745 Sheridan Ave Plainfield, NJ 07060

Am J Dis Child. 1988;142(12):1264. doi:10.1001/archpedi.1988.02150120018009

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Sir.—The article by Mauro and colleagues confirms an opinion I have held for 33 years of private pediatric practice. It has been my policy to examine the epiglottis visually in cases of croup to rule out epiglottitis, despite articles advising the substitution of a lateral neck roentgenogram for direct visualization. It is reassuring to find vindication in print.

My justification involves the following arguments:

  • The incidence of epiglottitis in my practice has not been the 4% reported by Mauro et al, but less than 0.1%. I have treated two cases in 33 years, compared with over 100 cases of croup annually. The hospital emergency department must receive the worst cases.

  • With the infant reclining and the neck extended, using a tongue depressor (I use narrow "Popsicle" sticks that are thicker and bend less easily than adult tongue depressors), a quick look elicits either a view of

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