Acute epiglottitis is a life threatening infection of the supraglottic structures. It more commonly occurs in early childhood but affects all age groups. Haemophilus influenzae type B is the usual pathogenic organism. The disease may progress so rapidly that sudden upper airway obstruction will occur, resulting in hypoxic brain damage or death. A retrospective study was completed on all patients (242) admitted to the Hospital for Sick Children in Toronto with a diagnosis of acute epiglottitis from January 1976 to December 1985. Prior to 1976, tracheotomy was the more common form of airway control but during the 10-year period reviewed endotracheal intubation was utilized almost universally in the 85% of patients having airway control and was associated with equally low morbidity. Airway obstruction prior to admission to the Hospital for Sick Children resulted in the subsequent deaths of five patients and persistent neurological deficits in four other surviving patients. The emergence of resistant strains of Haemophilus B organisms has altered antimicrobial management.