A case of vagal nerve schwannoma with a new physical sign is presented. The tumour was largely cystic and aspiration, performed twice, immediately elicited a cough reflex from the patient. Treatment was by total excision and the patient made a good recovery. Complete cystic degeneration of a vagal nerve schwannoma is uncommon. A search of the literature has failed to find any previous reports of fine needle aspiration causing a cough reflex in these tumours.