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Oropharyngeal Examination for Suspected Epiglottitis

Am J Dis Child. 1988;142(12):1263. doi:10.1001/archpedi.1988.02150120017006.
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Sir.—While I appreciate the trepidation some physicians might feel, the evaluation and recommendations by Mauro et al regarding the diagnosis of acute epiglottitis really ought not to be controversial. How many children have been unnecessarily subjected to, or have almost undergone, intubation for an incorrect diagnosis of acute epiglottitis? The first tenet of physical examination is inspection, not inference. I was taught the need for and safety in direct inspection of the epiglottis, using a good flashlight and sometimes a tongue depressor, by a wise and experienced senior attending pediatrician over 20 years ago.

As a purely personal preference in patient management, I would suggest the following compromise between the "do-lookers" and the "don't-lookers" when epiglottitis is suspected.

  1. Mauro and colleagues' steps ([1] look with flashlight, with no instrument; and [2] look carefully, using a tongue depressor) should be sufficient. Use the tongue depressor, if needed, to depress the


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