Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.
1
Is any of this happening now?
Call 911
Call emergency services if a voice or speech change begins suddenly with facial drooping, arm weakness, confusion, severe imbalance, or difficulty understanding words.
Those symptoms can indicate a stroke and are not the usual gradual pattern of spastic dysphonia.
Other emergency signs, for anyone
Someone who is struggling to breathe, gasping, choking, or cannot get words out
Someone who has chest pain, tightness or pressure lasting more than a few minutes
Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
Someone who is unconscious, or cannot be woken
Someone who is bleeding heavily and it will not stop with firm pressure
Someone who has had a seizure that will not stop, or does not wake up afterwards
Someone who has lips or skin that look pale, blue, grey or blotchy
Someone who you believe has taken an overdose or swallowed something poisonous
2
Is any of this happening?
Be seen today
Contact your treatment team promptly if you develop significant coughing with drinks, worsening swallowing trouble, or unexpected shortness of breath after a botulinum toxin injection.
Seek urgent medical care for:
New noisy breathing or difficulty getting enough air
Inability to swallow saliva
Repeated choking or signs that food or drink entered the lungs
3
Does any of this apply?
Book an appointment
Arrange a routine assessment if a strained, breathy, or breaking voice lasts for several weeks, keeps returning, or interferes with daily life.
Earlier assessment is appropriate if you use your voice professionally or have a history of head and neck cancer, neck surgery, smoking, or recent intubation.
Every sign above is quoted from the sofidex article on Spastic dysphonia. If you are not sure, err upward — it is always reasonable to be checked.