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September 8, 1978

Examination for Epiglottitis

Author Affiliations

Montreal Children's Hospital Montreal

JAMA. 1978;240(11):1141. doi:10.1001/jama.1978.03290110039015

To the Editor.—  A feature story in the MEDICAL NEWS section (239:94, 1978), "Misdiagnosis of Acute Epiglottitis Can Be Fatal," deserves further comment. Although I agree with the general thrust of the story and am pleased to see this potentially lethal problem brought to the attention of the general medical audience, one portion of the text is misleading and potentially dangerous.In the sixth paragraph, Dr Rivers is quoted as recommending laryngoscopy (direct or indirect) to confirm the diagnosis of epiglottitis. To the inexperienced, this advice, if not further qualified, could lead to a disaster. The airway is unstable in epiglottitis; a minor stimulus such as a reflex gag can be sufficient to provoke complete airway obstruction1,2 (229:671, 1974). Although many patients may be successfully examined by careful tongue depression and direct visualization of the epiglottis, and some may tolerate laryngoscopy (230:821, 1974), it is rarely possible to predict