OBJECTIVES To review the literature involving removal of sharp foreign bodies from the hypopharynx and to present a case of a triple-barbed fishhook removed from the hypopharynx with suspension microlaryngoscopy. STUDY DESIGN Literature review and case presentation. METHODS Review of the literature was done using a MEDLINE search with the keywords hypopharynx, foreign bodies, and laryngoscopy. RESULTS Review of the literature revealed no prior description of either foreign body removal using microlaryngoscopy or report of the removal of a triple-barbed fishhook from humans. CONCLUSION Removal of sharp foreign bodies from the aerodigestive tract always presents a technical challenge, and this case of a hypopharyngeal triple-barbed fishhook introduces new operative techniques. By using microlaryngoscopy and bimanual instrumentation to manipulate and remove the fishhook, an open surgical procedure was avoided.