with hoarseness, dyspnea and sore throat. Since the morning of admission, the patient had drooling as he was unable to swallow saliva. His symptoms were aggravated when supine. He denied fever or cough. His vital signs were normal. Temperature was 36.8 C. Remainder of the examination was remarkable only for an erythematous posterior pharynx and stridor on auscultation of the neck. Laboratory evaluation revealed a white cell count of 21,700 with 87% neutrophils and a normal hematocrit, platelets and normal routine serum chemistries. Lateral view of the neck showed an edematous, thumb shaped epiglottis. Blood cultures revealed no bacterial growth, but throat culture grew Haemophilus influenza type b. The patient received intravenous methylprednisone and cefuroxime. His symptoms improved and he was discharged on the fifth hospital day. DISCUSSION: Acute epiglottis has increasingly become an adult disease, probably as result of immunization of children against Haemophilus influenza type b. A high index of suspicion is required in any patient with sudden onset of " 4 Ds" dyspahgia, dysphonia, dyspnea and drooling. The frequency of positive blood culture is lower in adults than in children. A lateral cervical soft tissue x-ray is a useful test with sensitivity of 79±90% and specificity of 86±90%. Indirect laryngoscopy is the confirmatory test needed only if diagnosis remains in doubt after initial evaluation. Conservative medical management consisting of antibiotics and corticosteroids with vigilant monitoring are the mainstay of therapy in adults. Prophylactic intubation is not recommended. Prognosis of adults with acute epiglottitis is good with early recognition and prompt treatment.