Kristal Riska Mills
Principal Investigator
Assistant Professor of Head and Neck Surgery & Communication Sciences
Sherri L. Smith
Principal Investigator
Associate Professor of Head and Neck Surgery & Communication Sciences
Associate Professor in Population Health Sciences


Scientific Focus

Our research focuses to advance our understanding of hearing and balance disorders through development of innovative assessment and treatment techniques, and service delivery approaches. Furthermore, it is our goal to carry out multi-disciplinary research to better understand how hearing loss and balance disorders impact the health and well-being of the whole person, in addition to their significant others and the public at large.

Key Projects Underway

  • Drs. Smith and Francis and colleagues are conducting a pragmatic, multisite clinical trial comparing the effectiveness of three different hearing screening protocols in primary care settings. In the second phase of the project, we are examining the qualitative barriers to seeking hearing health care and evaluating the red flag conditions that potentially require medical or surgical management. This work is supported by the National Institute of Deafness and Other Communication Disorders through an R21/33 mechanism and is being conducted in collaboration with the Duke Primary Care Research Consortium. Identifier: NCT02928107
  • Dr. Smith holds a 3/8th appointment as a Research Audiologist at the Durham Veterans Affairs (VA) Health Care System. She is carrying out a study examining the efficacy of a coupler-based fitting approach for experienced users receiving replacement hearing aids. The results of this study will determine the efficacy of a coupler-based hearing-aid fitting protocol that would not require the Veteran to attend the fitting appointment, thereby contributing to improved Veteran-Centric care. The study is supported by a Merit Review sponsored by the VA Rehabilitation Research and Development Service. Identifier: NCT03569228
  • As a co-investigator on the a CDMRP Department of Defense grant, Dr. Riska is collaborating with colleagues to determine factors that contribute to the successful treatment outcomes of patients with mild traumatic brain injury/blast-related dizziness. Although post-concussive dizziness may resolve over time for many individuals with mild traumatic brain injury the likelihood of its worsening at three months post-injury is greater than other post-concussive symptoms. Chronic dizziness is an adverse prognostic indicator and may be the most persistent symptom adversely to affect clinical outcome and disease course. This grant leverages existing VA and DoD health databases as well as prospective data collection to determine factors that impact long-term recovery of post-concussion dizziness.
  • Drs. Riska and Smith are part of an inter-disciplinary team (ENT, audiology, geriatrics, sociology) examining the impacts of facemasks on patient-provider communication and healthcare outcomes. This project is funded by Duke Bass Connections:…)
  • Drs. Riska and Smith have an internally funded study to examine the impact of hearing loss on falls/falls risk and the extent to which traditional hearing aids mitigate falls risk.  Drs. Riska and Smith have presented this work at two recent conferences (American Auditory Society 2019, 2020)
  • Drs. Smith and Riska and colleagues are mentoring a medical student, Ryan Huang, who is examining the impact of hearing loss on surgical outcomes including complication rates, length of stay, and readmission rates. The results of this work will determine if and to what degree hearing loss contributes to these surgical outcomes.
  • Drs. Riska, Smith and colleagues are mentoring Anisha Singh, a Duke medical student, who is examining the impact of vestibular loss on developmental milestones in children with hearing loss.

Selected Achievements

  • Dr. Smith was among the first to systematically introduce and apply the self-efficacy framework to audiologic rehabilitation. Self-efficacy is the domain-specific confidence an individual has for learning new skills to achieve a given behavior, including health behaviors. Hearing loss and tinnitus are conditions that require the patient to manage their daily listening and communication interactions, and they often need to learn new skills to do so successfully. Through this work, Dr. Smith has developed patient reported outcome measures to assess self-efficacy in the audiology clinic or in research including: Measure of Audiologic Rehabilitation for Self-Efficacy for Hearing Aids (MARS-HA), the Listening Self-Efficacy Questionnaire (LSEQ), and the Self-Efficacy for Tinnitus Management Questionnaire (SETMQ).
  • Dr. Smith’s research examines the interplay of age, hearing loss, speech perception and/or aspects of cognition and auditory working memory. A result of this work was the development of the Word Auditory Recognition and Recall Measure (WARRM), which is an auditory working memory measure that is a complement to the reading span measure. Abbreviated versions of this test were also developed for potential clinical use.
  • Drs. Riska, Smith and colleagues recently were awarded a Duke BASS Connections grant to examine the impacts of facemasks on patient-provider communication and healthcare outcomes.
  • Dr. Smith and colleagues were recently awarded a Patient Center Outcomes Research Institute project to evaluate the use of unilateral versus bilateral hearing aids for the treatment of age-related hearing loss. This is a multi-site project in collaborate with Vanderbilt University.
  • Ryan Huang, third-year Duke University Medical Student in our lab, was awarded a Duke University Clinical & Translational Science Institute Scholarship to support his work on examining the impact of hearing loss on surgical outcomes.


1. Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA)

2. Listening Self-Efficacy Questionnaire (LSEQ)

3. Self-Efficacy for Tinnitus Management Questionnaire (SETMQ)

4. Style Preference Survey (SPS)

Advanced Training

Duke University students and residents interested in a research project related to hearing or vestibular/balance should contact the lab PIs to learn about opportunities. Dr. Smith is an approved third-year Duke University medical student research mentor. External students and learners are also encouraged to contact lab PIs to learn more about opportunities.

Contact Us

Sherri L. Smith, AuD, PhD
(919) 613-1110

Kristal M. Riska, AuD, PhD
(919) 681-9458


Sherri L. Smith, AuD, PhD

Kristal M. Riska, AuD, PhD


Sherri L. Smith, AuD, PhD

Kristal M. Riska, AuD, PhD