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The most difficult part of the evaluation in these patients is to perform the exam WHEN the patient is actually having symptoms (ie, during exercise). Doing an evaluation when without symptoms usually results in a normal exam (not surprisingly).
That's where the pulmonary stress test comes in. The philosophy behind this test is to allow for an evaluation when the patient is actually having symptoms.
Under a controlled situation, the patient is asked to start exercising on a treadmill or bicycle. Heart rate, EKG, respiratory rate, etc are all monitored during exercise. When symptoms of stridor or shortness of breath occur, the ENT performs a fiberoptic laryngoscopy exam on the spot to evaluate vocal cord motion and laryngeal structure. In some cases, even awake bronchoscopy may be performed to look for tracheomalacia.
Our office in cooperation with Fauquier Hospital offers this service.