A videofluoroscopic study shows post-swallow vallecular residue occupying more than 50 percent vallecular height. What is the most likely overt symptom?

• A. Watery eyes during swallowing
• B. Oral pocketing of foods
• C. Coughing after swallowing
• D. Esophageal reflux

Answer: (C)

Post-swallow residue in the valleculae that occupies more than half the vallecular height signals a significant pharyngeal swallow impairment with material left near the airway. When swallowed material remains in or near the laryngeal inlet, the airway defense reflex is triggered after the swallow, producing a cough to expel it. That’s why coughing after swallowing is the most likely overt symptom.

The other options don’t align as directly with this finding: watery eyes during swallowing aren’t tied to swallow mechanics, oral pocketing refers to material staying in the mouth rather than in the pharynx, and esophageal reflux involves a later stage after swallowed material has already passed the pharynx.