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October 1973


Author Affiliations

Department of Otolaryngology Walter Reed Army Hospital Washington, DC 20012

Arch Otolaryngol. 1973;98(4):291. doi:10.1001/archotol.1973.00780020301018

To the Editor.—Like many otolaryngologists I have been searching for a really effective treatment for epiglottitis; a way to avoid tracheotomy. I would welcome a modality that takes the threat of airway obstruction out of epiglottitis as racemic epinephrine has in most cases of laryngotracheobronchitis.1 Nasotracheal intubation is not the answer. It is substituting one suboptimal method of treatment for another.

There is no question that tracheotomy is a potentially hazardous procedure but in skilled hands there should be virtually no mortality. In fact, although figures are not available, I suspect that the mortality in failure to intubate successfully nationwide is higher than that directly attributable to surgery in epiglottitis. For this reason, whenever possible, a capable tracheotomist should be in attendance at all attempts to intubate. Nursing care is more critical with intubated children than tracheotomized children as they tend to pull out the former with

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