To examine patient characteristics related to airway intervention in acute epiglottitis and how the intervention affected the further course of the disease, 46 pediatric and 49 adult cases were retrospectively evaluated. All three airway management approaches, namely observation, nasotracheal intubation and tracheotomy were needed in both the children and adults. Five out of every six children needed an artificial airway, while observation was sufficient in three out of every five adults. H influenzae type b bacteremia in children, a short duration of the symptoms in adults and most important, respiratory distress in both were the best predictors of the need for an artificial airway. Nasotracheal intubation may be a successful means of implementing an artificial airway, but it is a technically demanding procedure and complications are frequent. Despite the recent changes in the occurrence of acute epiglottitis it remains a potential emergency situation both in children and adults.