In recent years, the efficient removal of organic pollutants from wastewater has emerged as a critical area of global research interest. Against this backdrop, an array of innovative technologies for wastewater treatment has been developed. Among numerous advanced oxidation processes (AOPs), periodate (PI), an emerging oxidizing agent in AOPs, has garnered significant attention from researchers. Particularly, the integration of ultrasound (US)-activated PI systems has been recognized as an exceptionally promising approach for the synergistic degradation of organic pollutants in wastewater. In this paper, we conducted a thorough analysis of the mechanisms underlying the degradation of organic pollutants using the US/PI system. Furthermore, we comprehensively delineated the effects of ultrasonic power, periodate concentration, temperature, pH, coexisting inorganic ions, and dissolved organic matter on the removal efficiency of organic pollutants and summarized application cases of the US/PI system for the degradation of different pollutants. Finally, we also offered prospective discussions on the future trajectories of US/PI technology development.