Which feature on a videofluoroscopic swallow study suggests oropharyngeal dysphagia?

• A. Vallecular/pyriform sinus residue
• B. Aspiration during or immediately after swallow
• C. Esophageal dilation
• D. Gastric reflux

Answer: (B)

Aspiration during or immediately after a swallow on videofluoroscopic swallow study directly shows airway protection failure during the pharyngeal stage, which is the hallmark of oropharyngeal dysphagia. When material enters the airway at that moment, it reveals that the swallow timing and laryngeal closure aren’t coordinating properly, signaling dysfunction at the oropharyngeal level.

Residue in the vallecular or pyriform sinuses can indicate incomplete pharyngeal clearance or weak pharyngeal contraction, but it doesn’t necessarily mean material entered the airway. Esophageal dilation and gastric reflux point to problems below the oropharynx (esophagus or stomach), not the oropharyngeal swallow mechanism.