Stridor is an alarming clinical sign that indicates critical narrowing of the airway and it is associated with a variety of etiologies. We carried out a review of literature on stridor in adults presenting from the community, in order to outline the main causes and discuss the management of patients with advanced cases of perilaryngeal obstruction. Adult stridor was reported in 249 patients from 99 publications. Approximately 50% of patients required invasive ventilation and admission to critical care unit. Mortality was 6.4%. Most common systematic cause was neurological in origin and the commonest local causes were vocal cords conditions. Efficient evaluation of the stridorous patient and early multidisciplinary approach is of paramount importance and a key determinant of survival.