Ultrasonic small scale flow reactors have found increasing popularity among researchers as they serve as a very useful platform for studying and controlling ultrasound mechanisms and effects. This has led to the use of these reactors for not only research purposes, but also various applications in biological, pharmaceutical and chemical processes mostly on laboratory and, in some cases, pilot scale. This review summarizes the state of the art of ultrasonic flow reactors and provides a guideline towards their design, characterization and application. Particular examples for ultrasound enhanced multiphase processes, spanning from immiscible fluid–fluid to fluid–solid systems, are provided. To conclude, challenges such as reactor efficiency and scalability are addressed.