Background <p>Incidents of pharyngeal foreign bodies are common in otolaryngological emergencies. In most cases, foreign bodies are easily identified and removed with or without the aid of flexible laryngoscopy. However, fully embedded foreign bodies in the tonsil are extremely rare and present a unique challenge for otolaryngologists.</p> Case summary <p>A 53-year-old Han male had a toothbrush head embedded in the palatine tonsil for 1 month, resulting in a prolonged discomfort and delayed diagnosis. The final diagnosis was a foreign body (toothbrush head) in left tonsil, established through computed tomography, medical history, and surgery. The foreign body was detected and removed from the oropharynx under general anesthesia. The patient recovered uneventfully during the 2-week follow-up.</p> Conclusions <p>Accurate diagnosis of pharyngeal foreign body is the key to successful treatment. For patients suspected of chronic foreign body ingestion, it is imperative to comprehensively assess the history, physical examination, and imaging. Surgery is recommended for complicated cases of embedded pharyngeal foreign bodies.</p>