Fifteen adults with acute epiglottitis are discussed. Three required tracheostomy because of delayed diagnosis. There were no deaths. Epiglottitis occurs more often in adults than is generally recognized. The early symptoms of epiglottitis in adults are sore throat and dysphagia. Any patient with acute, painful dysphagia should have indirect laryngoscopy to rule out epiglottitis. Throat and blood cultures were obtained from 14 of our cases. Cultures from only two patients were positive for Hemophilus influenzae, type B; cultures from the other 12 patients did not grow any bacterial pathogens. The primary treatment of adult epiglottitis is intravenous steroids, antibiotics, and humidified oxygen. Observation by the managing physician is mandatory during the first four hours of treatment. Tracheostomy is indicated in progressive disease.

The occurrence of iatrogenic injury to the adult hypopharynx and cervical eso hagus has been casually documented by direct sur ical exploration, endoscopy, radiography an$ occasionally, by autopsy. To provide meaningful Lowledge about the incidence of injury, the nature of the lesions, the character of the offending instruments and those injury-rone patients, a consecutive auto sy series was performed, focusing upon the pathology of the &popharynx and cervical esopfagus. One hundred and forty-nine consecutive hypopharyngealcervical esophageal specimens were examined. Sixty-nine percent of the patients had metal instruments or soft, flexible tubing placed through their oral and nasal pharynges. Sixty percent of those instrumented showed injury. All instruments used were found to have caused injury, suction catheters being implicated for the first time. Specific grou s were found to be injuryprone, the most susceptible being those with thrombocytopenia. O n b two percent of all injuries were noted antimortem.

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