What is the gold standard for diagnosing acute epiglottitis?

The gold standard for diagnosing acute epiglottitis is laryngoscopy. This procedure allows direct visualization of the epiglottis and surrounding structures, providing definitive evidence of inflammation, swelling, or other abnormalities characterizing epiglottitis. During laryngoscopy, the clinician can assess the degree of obstruction and make informed decisions about immediate management, including airway protection if necessary.

While physical examination is important, it often does not provide sufficient information to confirm a diagnosis, especially in cases where the patient may have significant swelling that might not be visibly apparent. Lateral neck X-ray can sometimes show a "thumbprint sign" indicative of epiglottitis, but it is not considered definitive and may not always be performed in acute settings. Ultrasound is less commonly used in this context and does not provide the detailed views of the epiglottis that laryngoscopy does. Therefore, laryngoscopy stands out as the most direct and effective method for diagnosing acute epiglottitis.