Sir.—Since I have been present at the death or near death of several patients with epiglottitis, I feel constrained to respond to your request1 and to the article by Mauro et al. I also wish to call attention to previous discussions of this subject.2,3
In none of the six patients with epiglottitis described by Mauro and colleagues was the epiglottis visualized by "light alone, simply asking the child to open his mouth." This is consistent with my own study4 in which the epiglottis was visualized in none of three patients. That study was extended for several years and in no instance was the epiglottis visualized in a patient with epiglottitis when he or she was examined sitting up, with voluntary opening of the mouth, without a tongue blade. This procedure is nearly risk-free; none of my patients had acute dypsnea as a result of it.
RAPKIN RH. Oropharyngeal Examination for Suspected Epiglottitis. Am J Dis Child. 1988;142(12):1261. doi:10.1001/archpedi.1988.02150120015002
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