Sir.—The management of acute epiglottitis is rendered uncertain by the common use of the term total [or complete] obstruction in describing the pathogenesis of its disastrous consequence. Mauro et al recommend cautious direct examination to diagnose acute epiglottitis and minimize the danger of total airway obstruction. Were total obstruction a substantial risk, cautious direct examination might be appropriate, as it is following total obstruction due to the aspiration of a foreign body. In such circumstances time is available, labored respirations continue, circulation persists, and death is not abrupt.
There is no evidence, however, that total obstruction occurs in acute epiglottitis. Even those reports that call the feared deterioration total (or complete) obstruction uniformly describe the cessation of respiration and the frequently associated asystole.1,2 The airway is still patent. Bag ventilation through an external mask is still effective3,4 and is probably the optimal emergency procedure.5,6 The problem is