Which finding on a videofluoroscopic swallow study is commonly associated with oropharyngeal dysphagia?

• A. Vallecular/pyriform sinus residue
• B. Esophageal dilation
• C. Gastric reflux
• D. Normal airway protection

Answer: (A)

The key idea here is that oropharyngeal dysphagia shows problems with moving the bolus from the mouth through the pharynx and protecting the airway during that phase. On a videofluoroscopic swallow study, one of the most telling signs is residue that remains in the valleculae or pyriform sinuses after a swallow. This indicates incomplete clearing of the bolus from the pharynx, reflecting impaired pharyngeal constriction, reduced tongue base retraction, or issues with laryngeal elevation—all of which point to pharyngeal phase dysfunction and a higher risk of aspiration.

Esophageal dilation points to issues in the esophageal phase rather than the pharyngeal phase, so it isn’t the typical VFSS marker of oropharyngeal dysphagia. Gastric reflux involves backward flow from the stomach into the esophagus and is not specific to the oropharyngeal swallow. Normal airway protection would suggest that the airway is being adequately guarded, which does not illustrate the pharyngeal clearance problems that characterize oropharyngeal dysphagia.