Upper airway obstruction is one the most feared condition in Otolaryngology.

Acute upper airway obstruction usually requires prompt tracheostomy as a lifesaving act. Through assessment and appropriate diagnosis and management of underlying cause are mandatory and at times even can avoid tracheostomy and its potential complications. We describe a case of severe laryngopharyngeal reflux (LPR) in 63-year-old man, causing acute stridor and airway obstruction lead to emergency tracheostomy. According to our literature review this may be the first case of LPR implicated in acute airway obstruction.