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A plateful of fish is sometimes as dangerous as it is delicious: small fish bones have a tendency to get stuck as they travel between our mouths and gullets.

Cindy Goodyer, for example, was enjoying a fish dinner with her family in Montreal, Quebec, around 30 years ago when she felt the uncomfortable prickle of a fish bone lodged in her sinuses. A doctor pinpointed the bone’s location—it was stuck in her left Eustachian tube, a sinus cavity connected to the ear. Mucus had covered the bone, blocking the tube and her hearing. Luckily, after a few weeks, the mucus pellet seemed to disappear on its own. To this day, Goodyer’s grown children are still put off by fish.

Goodyer’s fish-bone story is a little unusual—most bones get stuck in the throat. But her story is typical in that the bones most likely to get caught belong to fish, particularly in East Asian countries where locals often buy whole fish to cook at home. While most of these throat-piercing incidents are harmless, the situation could lead to complications, such as perforations of the esophagus, neck infections, or abscesses.

Researchers from the Department of Otolaryngology-Head and Neck Surgery at Japan’s Tohoku University Graduate School of Medicine, recently reviewed cases of patients needing medical care after ingesting fish bones. They analyzed 270 cases from 2015 to 2020, looking for patterns. Most incidents occurred in children under the age of 10 and in adults over 40. One fish stood out as the biggest troublemaker: eel. Out of all the patients reviewed, 34 had eel bones lodged in their throat. From 23 patients, doctors directly removed bones using forceps. For the rest of the patients, doctors needed an endoscope, a long flexible tube lowered into the throat like a plumber’s snake. Though eel isn’t the most commonly eaten fish species in Japan, it’s full of tiny bones.

The next most common kind of bones to get lodged were unsurprising: mackerel, salmon, and flounder. These are the most frequently consumed fish species in the country. Flounder bones, however, were the most common type of fish’s bone to be lodged deeper in the throat, the most likely to stay stuck, and the most likely to require an invasive technique for removal. Of the study’s 29 flounder cases, 17 required endoscopic removal and two required surgical removal.

While the study provides insights into the potential treatment and removal of fish bones in Japan, the authors noted that the results could vary across demographics, depending on cooking methods and popularity of fish. For future research, they suggest comparing cases across different populations. Perhaps in the future, with better data on risky fish species and their bone-removal methods, the Goodyers will be a little more receptive to a fish dinner.