Background <p>Fish bone foreign body ingestion is a common occurrence in the coastal state of Kerala in India, yet very few studies are available in the literature. The aim of this study is to evaluate the clinical assessment, investigation methods and management of patients with fish bone foreign body in the upper aero-digestive tract.</p> Results <p>A hundred patients presented to a tertiary care centre in Kerala with suspected fish bone as a foreign body alone were evaluated in this study. We observed a tendency for the impaction of foreign bodies to be more around the region of tonsils among the young population and the oesophageal area in the older population. The main presenting symptoms identified are localised foreign body sensation and pain. Evaluation warrants a thorough examination of the oral cavity and throat, followed by plain radiography in most of the cases, and missing or embedded bones or complications require a computed tomography. Most of the fish bones were recovered by either direct removal from the oropharynx or by flexible endoscopy. Complicated cases and penetrated foreign bodies needed neck exploration in a few cases.</p> Conclusion <p>We emphasise the role of clinical examination and radiological evaluation for locating the foreign body as well as ruling out complications and ad removal of the fish bones from aero-digestive tracts as early as possible to avoid complications.</p>