Acute management of vocal emergencies can be a difficult and stressful element in otolaryngology. A thoughtful history coupled with appropriate diagnostic instrumentation is the cornerstone of evaluating a patient with a vocal emergency. This article explores the differential diagnosis, evaluation, and treatment of vocal emergencies in the performer. Understanding the various causes of acute dysphonia in the performing artist as well as awareness of the additional pressures placed upon performing artists empowers the otolaryngologist to help patients in this interesting and unusual niche of the specialty.