Acute epiglottitis has traditionally been described as a paediatric disease in reports from temperate countries. There have been very few reports from tropical countries. This is a retrospective review of 32 cases of acute epiglottitis from Singapore over an eight-year period from 1992 to 1999. There were 31 adults and only one child. In Singapore, Haemophilus influenzae Type b (Hib) immunization in not routine, and thus the increased prevalence in adults cannot be attributed to Hib immunization. Eleven patients required airway intervention, of whom nine had endotracheal intubation and two had a surgical airway. Significant predictors for airway intervention included the sex of the patient, stridor, presence of airway compromise on examination and a "thumb sign" on the lateral neck radiograph. In adults, selective airway intervention is recommended as those without airway compromise at presentation recover very well with medical treatment alone.