In a thermoacoustic system, such as a flame in a combustor, heat release oscillations couple with acoustic pressure oscillations. If the heat release is sufficiently in phase with the pressure, these oscillations can grow, sometimes with catastrophic consequences. Thermoacoustic instabilities are still one of the most challenging problems faced by gas turbine and rocket motor manufacturers. Thermoacoustic systems are characterized by many parameters to which the stability may be extremely sensitive. However, often only few oscillation modes are unstable. Existing techniques examine how a change in one parameter affects all (calculated) oscillation modes, whether unstable or not. Adjoint techniques turn this around: They accurately and cheaply compute how each oscillation mode is affected by changes in all parameters. In a system with a million parameters, they calculate gradients a million times faster than finite difference methods. This review paper provides: (i) the methodology and theory of stability and adjoint analysis in thermoacoustics, which is characterized by degenerate and nondegenerate nonlinear eigenvalue problems; (ii) physical insight in the thermoacoustic spectrum, and its exceptional points; (iii) practical applications of adjoint sensitivity analysis to passive control of existing oscillations, and prevention of oscillations with ad hoc design modifications; (iv) accurate and efficient algorithms to perform uncertainty quantification of the stability calculations; (v) adjoint-based methods for optimization to suppress instabilities by placing acoustic dampers, and prevent instabilities by design modifications in the combustor's geometry; (vi) a methodology to gain physical insight in the stability mechanisms of thermoacoustic instability (intrinsic sensitivity); and (vii) in nonlinear periodic oscillations, the prediction of the amplitude of limit cycles with weakly nonlinear analysis, and the theoretical framework to calculate the sensitivity to design parameters of limit cycles with adjoint Floquet analysis. To show the robustness and versatility of adjoint methods, examples of applications are provided for different acoustic and flame models, both in longitudinal and annular combustors, with deterministic and probabilistic approaches. The successful application of adjoint sensitivity analysis to thermoacoustics opens up new possibilities for physical understanding, control and optimization to design safer, quieter, and cleaner aero-engines. The versatile methods proposed can be applied to other multiphysical and multiscale problems, such as fluid–structure interaction, with virtually no conceptual modification.