Objective: To report a case of fish spine impaction in the hypopharynx that initially was managed as a case of supraglottitis with retropharyngeal abscess Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A fifty-three year old male consulted at our institution due to complaints of odynophagia. Video laryngoscopy revealed a swollen epiglottis and arytenoids, with limitation of mobility of the left vocal fold. Plain radiographs showed a developing retropharyngeal abscess with no foreign body seen; however computed tomography scan revealed the presence of a fish spine impacted in the left piriform sinus. The patient underwent diagnostic rigid esophagoscopy with foreign body extraction (fish spine) under general anesthesia, after which there was noted improvement in the patient’s vocal fold mobility. Conclusion: We present a case of fish spine impaction causing retropharyngeal abscess and left vocal cord fixation. Through this study, the utility of complete history taking to determine the possible eitology of acute symptoms is emphasized. Radiography might not show radiolucent foreign bodies such as fish spine in our case.