Acute epiglottitis is a life-threatening infectious disease. Severe swelling of the epiglottis, arytenoids, or aryepiglottic fold is known to cause dyspnea and unless adequate treatment is delivered rapidly, the patient may suffocate. Therefore, early diagnosis and treatment are mandatory. We investigated the clinical features of patients with acute epiglottitis treated in our department and discussed the indications for airway management in such patients. In total 144 patients (90 males and 54 females ranging in age from 16-85 years) with acute epiglottitis were enrolled in the study. All patients were treated at Kagoshima University Hospital between October, 1999 and March, 2012. Airway management was required in 19 patients (13.2%) and the clinical characteristics of those subjects were compared with patients in whom airway management was not performed. Those findings suggest that when abnormal findings of the glottis were observed or the glottis findings could not be observed, airway management should be considered. Our results indicated that patients who needed airway management had severe dyspnea, more rapid and progressive aggravation of clinical findings and more severe swelling of the aryepiglottic folds compared to patients who did not require airway management.