The Thumb sign! Note the thumb- shaped bulge obstructing the airway (seen in black). The thumb represents the enlarged and oedematous epiglottitis and the condition is referred to as epiglottitis. Acute epiglottitis is a serious condition which necessitates hospital admission, antibiotic administration and systemic steroids to relieve oedema. Tracheostomy may be needed in severe respiratory obstruction.