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Source: https://writers.stackexchange.com/a/21270
License name: CC BY-SA 3.0
License URL: https://creativecommons.org/licenses/by-sa/3.0/

Source: https://writers.stackexchange.com/a/21270
License name: CC BY-SA 3.0
License URL: https://creativecommons.org/licenses/by-sa/3.0/

Example 1 puts us in the POV of the listener: _I heard a cough._ There's also the very tiny implication that it's not a _person,_ but perhaps an animal, a monster, or maybe a mechanical sound which appears to be a cough but later turns out to be a silenced bullet or something. But that depends on your story.

Example 2 does not at all to me imply "he knew someone was behind him" or "he was safe," but again, that's dependent on your story. If he's in a crowded bar, a cough may not be a big deal; if he's alone in his flat, someone else coughing is a problem.

Example 3 has the least immediacy to me because you've piled so many words between the person and the cough, plus you've used "flinch" (which means a jump at a sudden action) with "unexpectedly," making the adverb redundant. But if you're using it as part of an ongoing description, it still might work: _He stared fixedly at Moriarty's cold black eyes. The red lights crawling over John's face didn't distract him. He didn't even flinch when someone coughed behind him._ That context isn't "sudden," but it's piling on the tension.

Yes, there are pacing trade-offs. There are also style and content trade-offs. Do you want your audience to wonder what is coughing? Go with 1. Is the cough one of several events going on? Go with 3. If a cough is just a cough, then 2 is fine.

Original score: 1