Nearly one in three adults will experience a voice disorder at some point in their lifetime, often without realizing it may be connected to their overall health (Stachler et al., 2018). In this episode, we sit down with integrative otolaryngologist Dr. Linda Dahl to unpack how subtle changes in vocal tone, stamina, and clarity can serve as early clues to what’s happening systemically - from inflammation and hormonal shifts to nervous system stress, reflux, and microbiome changes - and what to do next depending on what you hear. From simple in-office listening strategies and targeted questions to appropriate referrals, lab considerations, and integrative support options, this episode helps clinicians effectively resolve common voice issues using a whole person approach.
Nearly one in three adults will experience a voice disorder at some point in their lifetime, often without realizing it may be connected to their overall health (Stachler et al., 2018). In this episode, we sit down with integrative otolaryngologist Dr. Linda Dahl to unpack how subtle changes in vocal tone, stamina, and clarity can serve as early clues to what’s happening systemically - from inflammation and hormonal shifts to nervous system stress, reflux, and microbiome changes - and what to do next depending on what you hear. From simple in-office listening strategies and targeted questions to appropriate referrals, lab considerations, and integrative support options, this episode helps clinicians effectively resolve common voice issues using a whole person approach.
CLINICAL TAKEAWAYS FROM THIS EPISODE
- Using the Voice as a Functional Assessment Tool in Whole-Person Care
- Changes in vocal tone, strength, endurance, or ease can provide early clues to systemic stressors such as inflammation, neuroendocrine imbalance, sleep disruption, microbiome dysfunction, or neurological or autonomic issues (Stachler et al., 2018).
- Integrative Treatment Considerations for Voice-Related Symptoms
- When vocal changes are present, supportive strategies may include addressing reflux, nutrient insufficiencies, nervous system regulation, breath mechanics, posture, microbiome optimization, referral to physical therapy and more (Stachler et al., 2018).
GUEST INTRODUCTION
Dr. Linda Dahl, MD, is a board-certified otolaryngologist, voice specialist, and integrative ENT physician. Her clinical work focuses on functional voice disorders, laryngeal health, and the intersection of vocal performance with systemic physiology. Dr. Dahl is known for integrating conventional ENT diagnostics with evidence-informed strategies that address inflammation, reflux, hormonal balance, and nervous system regulation. She regularly educates clinicians on using the voice as a meaningful window into whole-person health.
LABS, NUTRITION, AND LIFESTYLE SUPPORT
Dr. Dahl’s Clinical Lab Considerations for Voice Issues and Cough
- Inflammatory and metabolic markers as clinically appropriate (Stachler, 2018).
- Hormonal assessment as clinically indicated (Yalim, 2025).
Dr. Dahl’s Nutrition and GI Support Considerations for Vocal Issues and Chronic Cough
- Hydration assessment and counseling (Verdolini, 1994).
- Address reflux holistically if present (Stachler, 2018).
- Support the microbiome as clinically indicated and consider candidiasis overgrowth in patients with a history of oral corticosteroid use (Pinto, 2013).
Lifestyle and Nervous System Support for Voice
- Consider humidified air and environmental support for laryngeal tissue health (Levendoski, 2014).
- Vocal hygiene education, including pacing and rest—even in non-performers.
- Referral to voice therapy when functional misuse or strain is suspected (Wolfberg, 2024).
KEY MOMENTS
02:10 - Why the voice functions as a clinical vital sign
06:45 - Systemic conditions commonly reflected in voice changes
11:30 - Nutritional and hormonal influences on vocal tone
17:05 - Practical voice assessment in the exam room
22:40 - When to refer to ENT or voice therapy
28:10 - Reflux, inflammation, and chronic hoarseness
33:55 - The voice–nervous system connection
39:20 - Breath, posture, and vagal tone in vocal health
44:15 - Rapid-fire clinical insights on dysphonia
48:30 - Using the voice to track healing over time
DISCLAIMER
The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.
CITATIONS
- Stachler, R.J., Francis, D.O., Schwartz, S.R., Damask, C.C., Digoy, G.P., Krouse, H.J., McCoy, S.J., Ouellette, D.R., Patel, R.R., Reavis, C.W., Smith, L.J., Smith, M., Strode, S.W., Woo, P. and Nnacheta, L.C. (2018), Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngology–Head and Neck Surgery, 158: S1-S42. https://doi.org/10.1177/0194599817751030
- The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation. Stephen W. Porges. W.W. Norton & Company: New York, NY, 2011.
- Yalim SD, Bayram S, Bayar Muluk N, Cingi C. Association Between Menopause and Voice. Ear, Nose & Throat Journal. 2025;105(2):91-98. doi:10.1177/01455613251395924
- Levendoski EE, Sundarrajan A, Sivasankar MP. Reducing the negative vocal effects of superficial laryngeal dehydration with humidification. Ann Otol Rhinol Laryngol. 2014 Jul;123(7):475-81. doi: 10.1177/0003489414527230. PMID: 24690983; PMCID: PMC5441306.
- Verdolini K, Titze IR, Fennell A. Dependence of phonatory effort on hydration level. J Speech Hear Res. 1994 Oct;37(5):1001-7. doi: 10.1044/jshr.3705.1001. PMID: 7823546.
- Pinto CR, Almeida NR, Marques TS, Yamamura LL, Costa LA, Souza-Machado A. Local adverse effects associated with the use of inhaled corticosteroids in patients with moderate or severe asthma. J Bras Pneumol. 2013;39(4):409-417. doi:10.1590/S1806-37132013000400003
- Wolfberg J, Whyte J, Doyle P, Gherson S, Muise J, Petty B, Tolejano CJ, Hillman RE, Stadelman-Cohen T, Van Stan JH. Rehabilitation Treatment Specification System for Voice Therapy: Application to Everyday Clinical Care. Am J Speech Lang Pathol. 2024 Mar 7;33(2):814-830. doi: 10.1044/2023_AJSLP-23-00283. Epub 2023 Dec 19. PMID: 38101322; PMCID: PMC11001165.
