Recurrent hypopharyngeal carcinoma is usually not diagnosed until it has reached an advanced stage, and so carries a poor prognosis. The most common sites of recurrence of hypopharyngeal carcinoma are the local and neck areas. However, these sites sometimes present a challenge to the surgeon because they are difficult to approach. Herein, we report the case of a 59-year-old man who was diagnosed with left hypopharyngeal squamous cell carcinoma (pT3N2M0 stage IVa) in September 2006. He underwent bilateral salvage neck dissection and concurrent chemoradiotherapy to prevent recurrence. The follow-up neck computed tomography (CT) in December 2007 revealed a tumor in the right upper paratracheal space which was not seen in the July 2007 CT. We describe a feasible method to diagnose recurrent hypopharyngeal carcinoma located adjacent to the central airway using real-time endobronchial ultrasound-guided transbronchial needle aspiration and avoiding surgery.