The Socioeconomic Impact of Hearing Loss in U.S. Adults

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Emmett, Susan D, and Howard W Francis (2015). The Socioeconomic Impact of Hearing Loss in U.S. Adults. Otology & Neurotology, 36(3). pp. 545–550. 10.1097/MAO.0000000000000562 Retrieved from

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Susan D Emmett

Adjunct Associate Professor of Global Health

My research focuses on reducing hearing health disparities globally. I work with colleagues around the world to define the global burden of hearing loss and deepen our understanding of its social, economic, and health impact. We apply a public health approach that spans prevention, diagnosis, and treatment.

Fundamental to prevention is evaluating why hearing loss is so much more common in low-resource settings and investigating risk factors that are potentially modifiable. I have focused my prevention efforts on undernutrition, evaluating the contribution of early life malnutrition and micronutrient deficiencies to risk of hearing loss in Nepal. We are currently expanding this work to the Bolivian Amazon.

Diagnosis of hearing loss in remote settings brings unique challenges, including scarcity of audiologists and otolaryngologists, need for portable equipment, and lack of screening programs to identify affected children. I am currently leading a PCORI (Patient-Centered Outcomes Research Institute)-funded community randomized trial with the Norton Sound Health Corporation in Nome, Alaska to evaluate a new protocol for school hearing screening in 15 villages on the Bering Sea.  This study utilizes mobile health technology and telemedicine referral to identify previously undiagnosed hearing loss and efficiently connect Alaska Native children to care. The intervention has applicability across the state of Alaska, as well as in other remote, low-resource settings with a high prevalence of hearing loss and ear disease.

My research on treatment of hearing loss is focused on expanding access to cochlear implantation, a treatment for severe-to-profound hearing loss traditionally limited to high-resource settings. I have worked with collaborators in 14 countries to demonstrate that cochlear implantation can be a cost-effective treatment option in Sub-Saharan Africa and Latin America. We are expanding these studies to other regions of the world. 

Selected Grants

Addressing Childhood Hearing Loss Disparities in an Alaska Native Population: A Community Randomized Trial (AD-1602-34571), PCORI

Research Training in Otolaryngology (5T32DC000027-25), NIDCD/NIH

Global Control of Micronutrient Deficiency (OPPGH 614), Bill and Melinda Gates Foundation

Feed the Future Innovation Lab for Collaborative Research on Nutrition (AID-OAA-L-1-00006), USAID


Howard Wayne Francis

Richard Hall Chaney, Sr. Distinguished Professor of Otolaryngology

Dr. Howard W. Francis, is the Richard Hall Chaney, Sr professor of Otolaryngology and inaugural Chair of the Department of Head and Neck Surgery & Communication Sciences (HNS&CS) at Duke University Medical Center, where he is also the Chief of the Medical Staff of Duke University Hospital. He is a practicing neurotologist with research interests including practice innovations and clinical outcomes in the delivery of hearing health care. He is a senior editor of the Cummings Otolaryngology-Head and Neck Surgery Text, is a Director on the American Board of Otolaryngology-Head and Neck Surgery, a past member of the Otolaryngology Residency Review Committee of the ACGME, and a member of the Board of Directors of the Alexander Graham Bell Association for the Deaf and Hard of Hearing. Dr. Francis is a past president of the Society of University Otolaryngologists, past Education Director of the American Neurotology Society, and a recipient of the 2020 American Academy of Otolaryngology-Head and Neck Surgery Presidential Citation.

After completing his high-school education in Jamaica, and his bachelor’s degree at the University of Southern California in Los Angeles, Dr. Francis earned his medical degree from the Harvard-MIT division of Health, Science and Technology at Harvard Medical School, and then completed his internship, residency and fellowship training at the Johns Hopkins Hospital. He completed his Master’s in Business Administration with a focus in medical services management at the Johns Hopkins Carey Business School. After 19 years on the faculty at Johns Hopkins during which he served as Residency Program Director, Director of the Johns Hopkins Listening Center and Vice Director of the Department, he was appointed chief of HNS&CS at Duke in March 2017, and then the first Chair of the new Department in 2019.

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