Pear-shaped fistula is a very rare disease that develops clinically in childhood and is a congenital genetic disorder that usually requires multiple diagnoses before it can be clearly identified. The most important thing to do is to close the fistula with plasma, laser or electrocoagulation under general anesthesia and support laryngoscopy, so that it is not easy to form an infected channel and the fistula gradually recovers, but this treatment has a certain probability of recurrence. In conclusion, once discovered, most of the pear-shaped fistulas need to be treated surgically and conservative medication is ineffective.