Scholars@Duke
Susan D Emmett

Susan D Emmett

Adjunct Associate Professor of Global Health
Duke Global Health Institute
susan.emmett@duke.edu
Trent 333, Box 90519, Durham, NC 27708
310 Trent Drive, Box 90519, Durham, NC 27708

Scholarly Works - Journal articles

Can schools detect mild hearing loss? Evaluating screening accuracy and feasibility.

Journal article Int J Pediatr Otorhinolaryngol · August 2026 OBJECTIVES: We evaluated the feasibility and diagnostic accuracy of screening at lower levels to detect mild hearing loss in rural school settings in Alaska. METHODS: In this prospective, observational diagnostic accuracy study, we compared performance of ... Full text Link to item Cite

Mild loss, major consequences: Why mild hearing loss in children demands greater attention.

Journal article International journal of pediatric otorhinolaryngology · August 2026 Full text Cite

Time to Measure: A Proposed Theoretical Model for Head and Neck Cancer Intervals of Care.

Journal article World journal of otorhinolaryngology - head and neck surgery · June 2026 Head and neck cancer care delays are challenging, given the complexity of cancer care pathways, which leads to delays throughout the patient journey, from the symptom onset to treatment completion. Current models and literature addressing cancer care are l ... Full text Cite

Transforming Access to Hearing Care: Community Perspectives on School-Based Telehealth in Rural Appalachia.

Journal article Ear Hear · March 2026 OBJECTIVES: School-based hearing screening serves as a critical resource for children in rural areas to be screened and connected to hearing healthcare. Telemedicine interventions in schools have shown promise in connecting children to providers; however, ... Full text Link to item Cite

Assessing Environmental, Nutritional, and Genetic Factors for Otitis Media-Related Hearing Loss in Rural Alaska Native Children.

Journal article Ear and hearing · March 2026 ObjectivesThe majority of childhood hearing loss is from preventable ear infections, and rural regions, such as Alaska, home to Alaska Native peoples, are disproportionately affected. The underlying mechanisms for otitis media-related hearing loss ... Full text Cite

Understanding Risk Factors for Otitis Media in Rural Alaska Native Children: A Cohort Study.

Journal article Ear and hearing · March 2026 ObjectiveTo characterize the relationship between risk factors and otitis media in a rural Alaska Native population ages 1 to 4 yr.DesignThis prospective cohort study was a substudy to an analysis of hearing loss determinants in Alaska Na ... Full text Cite

Association of vision impairment and hearing impairment with encounters in the criminal justice system among children and young people: a systematic review and meta-analysis.

Journal article EClinicalMedicine · November 2025 BackgroundMore than 250,000 children <18 years were incarcerated globally in 2020, and 1.5 million cycle through custody annually. We reviewed studies reporting associations of vision/hearing impairment with the criminal justice encounters among y ... Full text Cite

Current status of school vision screening-rationale, models, impact and challenges: a review.

Journal article The British journal of ophthalmology · October 2025 Uncorrected refractive error is the leading cause of vision impairment in children globally, and studies have demonstrated that spectacle correction addresses the large majority of childhood vision impairment. Furthermore, trial evidence illustrates the be ... Full text Cite

Improving Access to Specialty Care for Rural Children Using Enhanced Hearing Screening and Specialty Telehealth Follow-Up in Rural Kentucky Schools: Protocol for a Hybrid Effectiveness-Implementation Stepped Wedge, Cluster-Randomized Controlled Trial (Appalachian STAR Trial).

Journal article JMIR Res Protoc · August 26, 2025 BACKGROUND: Rural populations are disproportionately affected by preventable childhood hearing loss, which is associated with speech and language delays, impaired social development, and decreased educational attainment. Rural schools are critical access p ... Full text Link to item Cite

School-based enhanced hearing screening and specialty telehealth follow-up for hearing loss among children in rural Alaska: study protocol for a hybrid effectiveness-implementation stepped wedge, cluster-randomized controlled trial (North STAR trial).

Journal article Trials · May 27, 2025 BACKGROUND: Childhood hearing loss has well-known profound implications for language development, school achievement, and future employment opportunities. School-based health programs can provide hearing screening, but access to specialists for follow-up c ... Full text Link to item Cite

School-Based Enhanced Hearing Screening and Specialty Telehealth Follow-Up for Hearing Loss Among Children in Rural Alaska: Study Protocol for a Hybrid Effectiveness-Implementation Stepped Wedge, Cluster-Randomized Controlled Trial (North STAR Trial).

Journal article Res Sq · April 1, 2025 BACKGROUND: Childhood hearing loss has well-known profound implications for language development, school achievement, and future employment opportunities. School-based health programs can provide hearing screening, but access to specialists for follow-up c ... Full text Link to item Cite

Access to Ear and Hearing Care Globally: A Survey of Stakeholder Perceptions from the Lancet Commission on Global Hearing Loss.

Journal article Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · March 2025 ObjectiveCharacterize global access to ear and hearing care (EHC) to inform future policy recommendations.Study designSurvey using convenience sampling.SettingSubjects were surveyed via contact lists of the World Health Organizat ... Full text Cite

Barriers to Research for Academic Otologists/Neurotologists in the United States.

Journal article Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · February 2025 ObjectiveThe physician-scientist workforce is shrinking in the United States. Academic otologists/neurotologists face a diverse set of barriers to successful careers. We aimed to characterize the factors affecting contemporary otology/neurotology ... Full text Cite

Telemedicine Referral to Improve Access to Specialty Care for Preschool Children in Rural Alaska: A Cluster-Randomized Controlled Trial.

Journal article Ear Hear · November 2023 OBJECTIVES: Preschool programs provide essential preventive services, such as hearing screening, but in rural regions, limited access to specialists and loss to follow-up compound rural health disparities. We conducted a parallel-arm cluster-randomized con ... Full text Link to item Cite

A Hybrid Deep Learning Approach to Identify Preventable Childhood Hearing Loss.

Journal article Ear and hearing · September 2023 ObjectiveChildhood hearing loss has well-known, lifelong consequences. Infection-related hearing loss disproportionately affects underserved communities yet can be prevented with early identification and treatment. This study evaluates the utility ... Full text Cite

Community Perspectives on Hearing Loss in Rural Alaska.

Journal article Ear and hearing · September 2023 ObjectivesThe aim of this study is to present an explanatory model of hearing loss in the Bering Strait region of Alaska in order to contextualize the results of a cluster randomized trial and propose implications for regional hearing-related heal ... Full text Cite

Prevalence of Childhood Hearing Loss in Rural Alaska.

Journal article Ear and hearing · September 2023 ObjectivesChildhood hearing loss has well-known lifelong consequences. Certain rural populations are at higher risk for infection-related hearing loss. For Alaska Native children, historical data on hearing loss prevalence suggest a higher burden ... Full text Cite

Mobile Health School Screening and Telemedicine Referral to Improve Access to Specialty Care in Rural Alaska: Integrating Mixed Methods Data to Contextualize Trial Outcomes.

Journal article Ear and hearing · September 2023 ObjectivesTo understand factors associated with outcomes in a cluster-randomized controlled trial that evaluated a telemedicine specialty referral intervention for school hearing screenings in 15 rural Alaskan communities.DesignHearing No ... Full text Cite

Changing the Paradigm for School Hearing Screening Globally: Evaluation of Screening Protocols From Two Randomized Trials in Rural Alaska.

Journal article Ear and hearing · July 2023 ObjectivesDiagnostic accuracy was evaluated for various screening tools, including mobile health (mHealth) pure-tone screening, tympanometry, distortion product otoacoustic emissions (DPOAE), and inclusion of high frequencies to determine the most ... Full text Cite

Potential Clinical and Economic Outcomes of Over-the-Counter Hearing Aids in the US.

Journal article JAMA Otolaryngol Head Neck Surg · July 1, 2023 IMPORTANCE: Over-the-counter (OTC) hearing aids are now available in the US; however, their clinical and economic outcomes are unknown. OBJECTIVE: To project the clinical and economic outcomes of traditional hearing aid provision compared with OTC hearing ... Full text Link to item Cite

Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA.

Journal article J Gen Intern Med · March 2023 BACKGROUND: While 60% of older adults have hearing loss (HL), the majority have never had their hearing tested. OBJECTIVE: We sought to estimate long-term clinical and economic effects of alternative adult hearing screening schedules in the USA. DESIGN: Mo ... Full text Link to item Cite

The Impact of Hearing Loss and Its Treatment on Health-Related Quality of Life Utility: a Systematic Review with Meta-analysis.

Journal article J Gen Intern Med · February 2023 BACKGROUND: Hearing loss significantly impacts health-related quality of life (QoL), yet the effects of current treatments on QoL utility remain uncertain. Our objective was to describe the impact of untreated and treated hearing loss on QoL utility to inf ... Full text Link to item Cite

Hearing-related quality of life in children and adolescents in rural Alaska.

Journal article Laryngoscope investigative otolaryngology · February 2023 ObjectiveThis study evaluated the Hearing Environments and Reflection on Quality of Life (HEAR-QL) questionnaire in rural Alaska, including an addendum crafted through community feedback to reflect the local context. The objectives were to assess ... Full text Cite

Environmental Factors for Hearing Loss and Middle Ear Disease in Alaska Native Children and Adolescents: A Cross-Sectional Analysis from a Cluster Randomized Trial.

Journal article Ear and hearing · January 2023 ObjectivesInfection-related childhood hearing loss is one of the few preventable chronic health conditions that can affect a child's lifelong trajectory. This study sought to quantify relationships between infection-mediated hearing loss and middl ... Full text Cite

Estimated Monetary Value of Future Research Clarifying Uncertainties Around the Optimal Adult Hearing Screening Schedule.

Journal article JAMA Health Forum · November 4, 2022 IMPORTANCE: Adult hearing screening is not routinely performed, and most individuals with hearing loss (HL) have never had their hearing tested as adults. OBJECTIVE: To project the monetary value of future research clarifying uncertainties around the optim ... Full text Link to item Cite

Validation of the Decision model of the Burden of Hearing loss Across the Lifespan (DeciBHAL) in Chile, India, and Nigeria.

Journal article EClinicalMedicine · August 2022 BACKGROUND: There is no published decision model for informing hearing health care resource allocation across the lifespan in low- and middle-income countries. We sought to validate the Decision model of the Burden of Hearing loss Across the Lifespan Inter ... Full text Link to item Cite

Mobile health school screening and telemedicine referral to improve access to specialty care in rural Alaska: a cluster- randomised controlled trial.

Journal article Lancet Glob Health · July 2022 BACKGROUND: School-based programmes, including hearing screening, provide essential preventive services for rural children. However, minimal evidence on screening methodologies, loss to follow-up, and scarcity of specialists for subsequent care compound ru ... Full text Link to item Cite

Expanding Clinical Trials Designs to Extend Equitable Hearing Care.

Journal article Ear and hearing · July 2022 Clinical trials are critically important to translate scientific innovations into clinical practice. Hearing healthcare depends on this translational approach to improve outcomes and quality of life. Across the spectrum of healthcare, there is a lack of di ... Full text Cite

The prevalence of Post-Ebola Syndrome hearing loss, Sierra Leone.

Journal article BMC infectious diseases · July 2022 BackgroundGlobally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world's population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in ... Full text Cite

Development and validation of DeciBHAL-US: A novel microsimulation model of hearing loss across the lifespan in the United States.

Journal article EClinicalMedicine · February 2022 BACKGROUND: Hearing loss affects over 50% of people in the US across their lifespan and there is a lack of decision modeling frameworks to inform optimal hearing healthcare delivery. Our objective was to develop and validate a microsimulation model of hear ... Full text Link to item Cite

The Road to Hearing Health Equity

Journal article Volta Review · January 1, 2022 Of the 1.6 billion people with hearing loss worldwide, over 1.2 billion live in underserved communities with the least access to hearing care. This includes preventable hearing loss in an estimated 42 million children who, without early identification and ... Full text Cite

Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review.

Journal article Journal of medical Internet research · December 2021 BackgroundHealth systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Cent ... Full text Cite

Middle Cranial Fossa Approach: The Incudomalleolar Joint as a Reliable Landmark.

Journal article International archives of otorhinolaryngology · July 2021 Introduction  The middle cranial fossa approach is performed by fewer neurotologists owing to a reduced number of indications. Consistent landmarks are mandatory to guide the surgeon in a narrow field. Objectives  We have evaluated the incus ... Full text Cite

The inaugural World Report on Hearing: From barriers to a platform for change.

Journal article Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery · May 2021 The inaugural World Report on Hearing was recently published by the World Health Organisation, and outlines the burden of hearing loss, and strategies to overcome this through preventative and public health approaches. Here, we identify barriers to wide-sc ... Full text Cite

Evidence gaps in economic analyses of hearing healthcare: A systematic review.

Journal article EClinicalMedicine · May 2021 BACKGROUND: Hearing loss is a common and costly medical condition. This systematic review sought to identify evidence gaps in published model-based economic analyses addressing hearing loss to inform model development for an ongoing Lancet Commission. METH ... Full text Link to item Cite

Lassa Fever Induced Hearing Loss: The Neglected Disability of Hemorrhagic Fever.

Journal article International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · November 2020 ObjectiveLassa fever (LF) a hemorrhagic fever endemic to Western has an incidence of approximately 500,000 cases per year. Here, we evaluate hearing loss and other sequelae following LF.MethodsThis case-control study enrolled laboratory c ... Full text Cite

Hearing Norton Sound: community involvement in the design of a mixed methods community randomized trial in 15 Alaska Native communities.

Journal article Research involvement and engagement · November 2020 Community involvement is important in good research practice. We led a community-based study to improve early detection and treatment of childhood hearing loss in rural Alaska. This study evaluated a cell phone-based hearing screening process and compared ... Full text Cite

Cost-effectiveness of School Hearing Screening Programs: A Scoping Review.

Journal article Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · June 2020 ObjectiveSchool hearing screening is a public health intervention that can improve care for children who experience hearing loss that is not detected on or develops after newborn screening. However, implementation of school hearing screening is sp ... Full text Cite

How the World's Children Hear: A Narrative Review of School Hearing Screening Programs Globally.

Journal article OTO open · April 2020 ObjectiveSchool hearing screening may mitigate the effects of childhood hearing loss through early identification and intervention. This study provides an overview of existing school hearing screening programs around the world, identifies gaps in ... Full text Cite

Expanding Access: Cost-effectiveness of Cochlear Implantation and Deaf Education in Asia.

Journal article Otolaryngol Head Neck Surg · October 2019 OBJECTIVE: To determine the cost-effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low- and lower-middle income countries in Asi ... Full text Link to item Cite

Hearing care across the life course provided in the community.

Journal article Bulletin of the World Health Organization · October 2019 Untreated hearing loss is recognized as a growing global health priority because of its prevalence and harmful effects on health and well-being. Until recently, little progress had been made in expanding hearing care beyond traditional clinic-based models ... Full text Cite

A Review of Hearing Loss Associated with Zika, Ebola, and Lassa Fever.

Journal article The American journal of tropical medicine and hygiene · September 2019 The neglected tropical diseases Zika, Ebola, and Lassa fever (LF) have all been noted to cause some degree of hearing loss (HL). Hearing loss is a chronic disability that can lead to a variety of detrimental effects, including speech and language delays in ... Full text Cite

Introducing the "ChOLE" Classification and Its Comparison to the EAONO/JOS Consensus Classification for Cholesteatoma Staging.

Journal article Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · January 2019 : Many previous attempts have been made to classify or categorize cholesteatomas. Recently, the European Academy of Otology and Neurotology and the Japanese Otological Society proposed a classification system based primarily on extension and complications. ... Full text Cite

Hearing Norton Sound: mixed methods protocol of a community randomised trial to address childhood hearing loss in rural Alaska.

Journal article BMJ open · January 2019 IntroductionChildhood hearing loss has implications for school achievement, economic outcomes and quality of life. This study will engage rural Alaska communities in research to improve the school hearing screening and referral process, partnering ... Full text Cite

Hearing Norton Sound: a community randomised trial protocol to address childhood hearing loss in rural Alaska.

Journal article BMJ open · January 2019 IntroductionThe population in rural Alaska experiences a disproprionately high burden of infection-mediated hearing loss. While the state mandates school hearing screening, many children with hearing loss are not identified or are lost to follow-u ... Full text Cite

Chronic Ear Disease.

Journal article Med Clin North Am · November 2018 Chronic ear disease is composed of a spectrum of otologic disorders intrinsically tied to Eustachian tube dysfunction. Presentation can range from asymptomatic findings on physical examination to critically ill patients with intracranial complications. Int ... Full text Link to item Cite

Global Hearing Loss Prevention.

Journal article Otolaryngol Clin North Am · June 2018 Hearing loss is the fourth leading contributor to years lived with a disability worldwide. Most recent estimates indicate that one-half of a billion people suffer from disabling hearing loss worldwide. The social and economic burden is significant. When at ... Full text Link to item Cite

Cost-effectiveness of CI in developing countries.

Journal article Current opinion in otolaryngology & head and neck surgery · June 2018 Purpose of reviewCost-effectiveness of cochlear implants is a major concern for expanding these services to low-income and middle-income developing countries.Recent findingsRecent studies have applied appropriate methodology to make deter ... Full text Cite

Birth seasons and heights among girls and boys below 12 years of age: lasting effects and catch-up growth among native Amazonians in Bolivia.

Journal article Annals of human biology · June 2018 BackgroundSeasons affect many social, economic, and biological outcomes, particularly in low-resource settings, and some studies suggest that birth season affects child growth.AimTo study a predictor of stunting that has received limited ... Full text Cite

Early childhood undernutrition increases risk of hearing loss in young adulthood in rural Nepal.

Journal article The American journal of clinical nutrition · February 2018 BackgroundPrevalence of young adult hearing loss is high in low-resource societies; the reasons for this are likely complex but could involve early childhood undernutrition.ObjectiveWe evaluated preschool childhood stunting, wasting, and ... Full text Cite

Child stunting is associated with weaker human capital among native Amazonians.

Journal article American journal of human biology : the official journal of the Human Biology Council · January 2018 ObjectivesWe assessed associations between child stunting, recovery, and faltering with schooling and human capital skills in a native Amazonian society of horticulturalists-foragers (Tsimane').MethodsWe used cross-sectional data (2008) f ... Full text Cite

Trends in Otitis Media and Myringotomy With Tube Placement Among American Indian and Alaska Native Children and the US General Population of Children After Introduction of the 13-valent Pneumococcal Conjugate Vaccine.

Journal article The Pediatric infectious disease journal · January 2018 BackgroundAmerican Indian/Alaska Native (AI/AN) children have experienced higher otitis media (OM) outpatient visit rates than other US children. To understand recent trends, we evaluated AI/AN OM rates before and after 13-valent pneumococcal conj ... Full text Cite

Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America.

Journal article Otol Neurotol · September 2016 HYPOTHESIS: Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. BACKGROUND: CI has been widely established as cost effective in North America and Europe a ... Full text Link to item Cite

Nutrition and hearing loss: a neglected cause and global health burden.

Journal article The American journal of clinical nutrition · November 2015 Full text Open Access Cite

GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa.

Journal article Otol Neurotol · September 2015 HYPOTHESIS: Cochlear implantation and deaf education are cost effective in Sub-Saharan Africa. BACKGROUND: Cost effectiveness of pediatric cochlear implantation has been well established in developed countries but is unknown in low resource settings, where ... Full text Link to item Cite

The socioeconomic impact of hearing loss in U.S. adults.

Journal article Otol Neurotol · March 2015 OBJECTIVE: To evaluate the associations between hearing loss and educational attainment, income, and unemployment/underemployment in U.S. adults. STUDY DESIGN: National cross-sectional survey. SETTING: Ambulatory examination centers. PATIENTS: Adults aged ... Full text Open Access Link to item Cite

Hearing loss is associated with decreased nonverbal intelligence in rural Nepal.

Journal article Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · January 2015 ObjectiveTo evaluate the association between adolescent and young-adult hearing loss and nonverbal intelligence in rural Nepal.Study designCross-sectional assessment of hearing loss among a population cohort of adolescents and young adult ... Full text Open Access Cite

Bilateral hearing loss is associated with decreased nonverbal intelligence in US children aged 6 to 16 years.

Journal article Laryngoscope · September 2014 OBJECTIVES/HYPOTHESIS: To evaluate the association between hearing loss and nonverbal intelligence in US children. STUDY DESIGN: The Third National Health and Nutrition Examination Survey (NHANES III) is a cross-sectional survey (1988-1994) that used compl ... Full text Link to item Cite

Acquired Glottic Web Formation in a 3-Year-Old Girl: Case Report and Literature Review.

Journal article International journal of pediatric otorhinolaryngology extra · September 2014 Pediatric glottic webs are most commonly congenital in origin. Acquired webs in children are typically traumatic in nature, primarily from external trauma or intubation. We report a unique variation of this post-traumatic etiology: a web centered at the ju ... Full text Cite

Gestational vitamin A deficiency: a novel cause of sensorineural hearing loss in the developing world?

Journal article Medical hypotheses · January 2014 Hearing loss is a substantial public health problem with profound social and economic consequences in the developing world. The World Health Organization (WHO) estimates that there are 360 million people living with disabling hearing loss globally, and 80% ... Full text Open Access Cite

Save the WHO program for hearing loss prevention

Journal article Hearing Journal · September 1, 2013 Full text Open Access Cite

Predicting virologic failure among HIV-1-infected children receiving antiretroviral therapy in Tanzania: a cross-sectional study.

Journal article J Acquir Immune Defic Syndr · August 2010 BACKGROUND: Many HIV care and treatment programs in resource-limited settings rely on clinical and immunologic monitoring of antiretroviral therapy (ART), but accuracy of this strategy to detect virologic failure (VF) among children has not been evaluated. ... Full text Open Access Link to item Cite