To the Editor.—
The extensive experience with epiglottitis in pediatric patients has generated several important principles concerning the management of epiglottitis that were not well delineated in the article by Ossoff and Wolff entitled "Acute Epiglottitis in Adults" (1980;244:2639).First, the advisability of manipulation of the patient with suspected epiglottitis by indirect laryngoscopy must be questioned. Although we could find no reports of morbidity or mortality associated with this procedure, manipulation of the pharynx with a tongue blade in children has been associated with sudden total airway obstruction. An endolateral neck roentgenogram is the preferred initial diagnostic procedure in patients with suspected epiglottitis. In our series of 19 patients with epiglottitis at Children's Memorial Hospital during a four-year period, the endolateral roentgenogram demonstrated the abnormal epiglottis in all cases. This degree of accuracy was also found in a recent series of adults with epiglottitis.1Expectant management of patients with
Willert C, Tanz R, Beck D. Management of Acute Epiglottitis. JAMA. 1982;247(1):26–27. doi:10.1001/jama.1982.03320260014009
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