Published: August 2, 2017

TED Fellow: Eradicating disparities in global hearing health

Susan D. Emmett, MD, MPH, a member of the 2017 class of TED (the 1984 Technology, Entertainment, and Design conference that became the 18 minute, great idea, “TED Talks”) Fellows, is one of 21 innovators from five continents selected to take the stage in August at TEDGlobal in Tanzania.

Susan D. Emmett, MD, MPH, a member of the 2017 class of TED (the 1984 Technology, Entertainment, and Design conference that became the 18 minute, great idea, “TED Talks”) Fellows, is one of 21 innovators from five continents selected to take the stage in August at TEDGlobal in Tanzania. She will present her research on addressing hearing health disparities on a global level. TED began in 1984 as a conference where Technology, Entertainment and Design converged, and today covers almost all topics — from science to business to global issues — in more than 100 languages.

“There are an estimated 1.1 billion people living with hearing loss worldwide, and over 80 percent of these individuals live in low- and middle-income countries,” Dr. Emmett stated. “The World Health Organization estimates that at least half of hearing loss cases are preventable, highlighting the urgency to address these tremendous disparities in global hearing health.”

Dr. Emmett is the first otolaryngologist selected as a TED Fellow. The program was founded in 2009¹ and now has 435 fellows from 94 countries, whose talks have collectively been viewed more than 155 million times.²

In its eight-year history, the TED Fellows program has created a powerful, far-reaching network—made up of scientists, doctors, activists, artists, photographers, filmmakers, entrepreneurs, inventors, journalists, and beyond—leading to many meaningful and unexpected collaborations.

“I’m humbled to be asked to be a TED Fellow. It is a tremendous honor to represent the field of otolaryngology-head and neck surgery and to be a voice for the importance of our specialty in global health,” said Dr. Emmett, assistant professor of surgery and global health at Duke University.

Dr. Emmett screening hearing in Bangladesh.

Dr. Emmett’s journey in August to Tanzania is grounded in her career start in public policy, beginning with her bachelor’s degree from Princeton University in Molecular Biology and the Woodrow Wilson School of Public and International Affairs. Prior to heading off to medical school, she worked in the Office of Science Policy at the National Institutes of Health and as a health legislative aide on Capitol Hill. This work gave her a foundation in policy that she continues to incorporate into her research.

She completed residency at Johns Hopkins, where she pursued the T32 research training program to gain experience in public health, including a Johns Hopkins Bloomberg School of Public Health Master of Public Health and a postdoctoral research fellowship at the school’s Center for Human Nutrition.

“The training and mentorship I received at Bloomberg has been invaluable preparation, providing the analytic tools and experience in large field trials that I need to tackle hearing health disparities on a global scale,” Dr. Emmett said. Her leadership in the field of global hearing health has been recognized early in her career, with invitations to speak at over 20 national and international conferences before TEDGlobal.

Sharing her work in Tanzania as a 2017 TED Fellow is particularly significant because it brings her full circle to the country where her commitment to global health began. In 2008, as a medical student at Duke University, Dr. Emmett received the prestigious Howard Hughes Medical Institute Research Training Fellowship that supported a year of research in Tanzania.

“I can’t imagine a more poignant place to speak about global hearing health disparities from the TED stage than in the country that has had an indelible impact on my life and career.”

In her research, Dr. Emmett works with colleagues around the world to define the global burden of hearing loss and better understand its social, economic, and health implications.

“Working with collaborators who live and serve in the countries and communities where our research is taking place is absolutely essential,” Dr. Emmett said. “Each project truly represents a team effort and reflects commitment and involvement from individuals across many fields and backgrounds.”

Dr. Emmett applies a public health approach to reducing hearing health disparities that spans prevention, early detection and 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,” Dr. Emmett said. Her preventive efforts have been focused on undernutrition, evaluating the contribution of early life malnutrition and micronutrient deficiencies to risk of hearing loss in Nepal.

“Micronutrient deficiencies such as vitamin A deficiency continue to be common across the Gangetic Plain of South Asia. One of the studies from our group that followed the cohort from a large community randomized trial of preschool vitamin A supplementation showed that in children who experienced recurrent otitis media, supplementation with a single high-dose vitamin A tablet every six months reduced their risk of young adult hearing loss by 42 percent. We need simple, low-cost solutions like this to stop hearing loss before it ever starts,” said Dr. Emmett.

“The adoption of scientific advancements into policy can be a slow process, which is why policy implications are always at the forefront of my mind in my research … I am constantly thinking about the disparities we want to reduce, where the knowledge gaps are, and how we are going to fill those gaps,” Dr. Emmett said.

A good example of this is Dr. Emmett’s work on diagnosis of hearing loss in remote communities. “Scarcity of audiologists and otolaryngologists, the need for portable equipment and lack of screening programs to identify affected children can make diagnosis in remote communities very difficult, both in the U.S. and abroad.”

The tremendous burden of childhood hearing loss in remote Alaska Native villages led Dr. Emmett to partner with colleagues at Norton Sound Health Corporation in Nome, AK. The team was awarded $1.5 million in funding from the Patient-Centered Outcomes Research Institute (PCORI) for a community randomized trial in 15 villages on the Bering Sea evaluating the ability of mobile health screening technology and telemedicine referral to identify previously undiagnosed hearing loss and efficiently connect Alaska Native children to care.³

“We have an incredible team of stakeholders who bring patient, parent, educator, and community perspectives to the project. The policy implications of the intervention are tremendous, both for the state of Alaska and globally. Alaska is leading the way in telemedicine and has the potential to greatly influence delivery of care in other remote environments.”

In addition, Dr. Emmett’s research on treatment of hearing loss has focused on expanding access to cochlear implantation. She has 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.

“As otolaryngologists, we see the impact that cochlear implants can have on a child’s life: improved language skills, higher likelihood of succeeding in mainstream education, greater job opportunities, and more. Unfortunately, availability of cochlear implants is limited in many low- and middle-income countries. We hope to change this trend by demonstrating cost- effectiveness of this treatment option.”

At TEDGlobal, Dr. Emmett is most looking forward to the people she will meet. “The TED Community brings changemakers together from across the globe. I am excited about the relationships and potential collaborations that will come from this experience,” said Dr. Emmett.

TED Fellows are selected “based on remarkable achievement, their strength of character, and on their innovative approach to solving the world’s tough problems. Fellows are invited to attend a TED conference, where they meet, exchange ideas, and connect with the larger TED community. They also give their own TED Talk—an unprecedented opportunity to disseminate their unique ideas to the world.”⁴

“I congratulate the TED Fellows Program for recognizing the importance of hearing loss as a major source of disability burden in the world, as well as the immense potential of Dr. Emmett to be a transformative agent in reversing these unrelenting trends and their downstream consequences for families and communities,” said Howard Francis, MD, MBA, chief of Duke’s Division of Head and Neck Surgery and Communication Sciences. “We are proud of Dr. Emmett’s achievement and are hopeful that it will elevate her cause of advancing global hearing health shared by many collaborators across Duke and within the Academy of Otolaryngology—Head and Neck Surgery.”

To learn more about Dr. Emmett’s effort to reduce disparities in global hearing health, go to http://globalhearinghealth.org/. For more information about the Alaska childhood ear and hearing study go to https://hearingnortonsound.com/.

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