Objective To analyze the related factors affecting the detection of difficult pharyngeal fishbone under 70° rigid laryngoscope. Methods A retrospective analysis was made of 490 adult pharyngeal fishbone patients who were treated in our department from January 2019 to May 2022, who underwent the author's detailed oropharyngeal and indirect laryngoscopy without fishbone, and then underwent 70° rigid laryngoscopy. According to the clinical data, the patients were divided into the detected group and the non-detected group according to whether the fishbone was detected. Univariate analysis and binary logistic regression analysis were performed on factors such as age, gender, time from ingestion to admission, symptoms, indicated side and position of neck, tongue height, tonsil size, and pre-treatment treatment of the two groups of patients.  Results Univariate analysis showed that age, gender, time from ingestion to admission, indicated side and position of neck, tongue height, tonsil size, and pre-treatment treatment had no statistical differences between the pharyngeal fishbone detection group and the non-detected group (P > 0.05), and the symptoms of the patients were significantly different between the two groups (P < 0.001). Binary logistic regression analysis showed that throat tingling was an independent risk factor for difficult pharyngeal fishbone detection under 70° rigid laryngoscope. (P<0.001), OR value and 95%CI were 2.762 (1.832-4.185). Conclusion Difficult pharyngeal fishbone patients with throat tingling need to go to the outpatient clinic for follow-up and complete laryngoscopy to reduce the possibility of missed diagnosis.