Lower Blepharoplasty.

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Functional Oral Intake in Primary Versus Salvage Laryngectomy.

OBJECTIVE: Advanced-stage laryngeal squamous cell carcinoma is treated with primary surgery or chemoradiation. We aim to determine if there are differences in postoperative functional oral intake in primary (PL) versus salvage laryngectomees (SL). STUDY DESIGN: Retrospective cohort study. SETTING: Patients who underwent laryngectomy between 2011 and 2021. METHODS: We examined demographic, diagnostic, treatment, and swallow function data pre- and postoperatively. A follow-up survey was distributed to assess current swallow status. RESULTS: One hundred twenty-five patients were included. Preoperatively, 68.8% of patients reported dysphagia. Median functional oral intake score (FOIS) was 4.0 [interquartile range, IQR: 1.0-6.75]. The SL group had lower preop FOIS [2.0; IQR: 1.0-4.75] that did not reach significance compared to the PL group [4.5; IQR: 1.0-7.0] (P = .052). 73.4% of patients had a feeding tube. The PL group was more likely to have the tube removed [odds ratio, OR: 2.4; confidence interval, CI: 1.0-5.7]. The SL group was more likely to require feeding tube placement more than 6 months postop [OR: 6.9; CI: 1.65-32.6]. SL FOIS scores improved by 3 months postop to 5 (SL ΔFOIS = 3, P = .0150). PL scores improved to 7 [PL ΔFOIS = 2, P = .0005] at 12 to 15 months. Sixty-nine patients were contacted for a follow-up survey and 16 completed this survey. 30.4% patients reported dietary restrictions (mean 4.4 years postop). CONCLUSION: Patients undergoing SL appear to obtain similar swallow outcomes compared to PL at 3 to 6 months postlaryngectomy, but plateau. The PL group continues to improve up to 1 year postoperatively. Fifty percent of patients report on-going dysphagia after 5 years.

Development and Validation of The Activity-Based Checks (ABCs) of Pain: A Functional Pain Scale.

The Activity-Based-Checks of Pain (ABCs) is a pain assessment tool incorporating activities of daily living and instrumental activities of daily living. Unlike widely used pain scales which are oftentimes unidimensional and highly subjective, the ABCs was designed to focus on function capabilities and limitations of patients due to pain. This study sought out to validate the factorial structure of the ABCs and assess its use in participants with chronic pain. Participants were recruited in two phases from Prolific - an online service designed to identify research participant recruitment based on study criteria. Phase one optimized the design of the ABCs, with 297 subjects selecting their preferred icon for each function and rating its understandability. The most preferred and understandable icons were then used in phase two, where 304 chronic pain participants completed the ABCs, PROMIS-29, additional PROMIS items that were analogous to the ABCs functions but not represented in the PROMIS-29, and the Brief Pain Inventory (BPI). Data was analyzed using exploratory factor analysis and confirmatory factor analysis demonstrating four factor loadings: multi-planal activities, sitting/hip flexor pain, walking/ambulation, and pain interference with lightweight unilateral activities. High internal consistency was demonstrated with all four factor loadings. Correlations between items in the ABCs, PROMIS, and BPI resulted in moderate to strong correlations demonstrating strong evidence for the validity of the ABCs as a functional pain assessment tool.

Disparities in Clinical Trial Enrollment and Reporting in Rectal Cancer: A Systematic Review and Demographic Comparison to the National Cancer Database.

BACKGROUND: Cancer care guidelines based on clinical trial data in homogenous populations may not be applicable to all rectal cancer patients. The aim of this study was to evaluate whether patients enrolled in rectal cancer clinical trials (CTs) are representative of United States (U.S.) rectal cancer patients. METHODS: Prospective rectal cancer CTs from 2010 to 2019 in the United States were systematically reviewed. In trials with multiple arms reporting separate demographic variables, each arm was considered a separate CT group in the analysis. Demographic variables considered in the analysis were age, sex, race/ethnicity, facility location throughout the United States, rural vs urban geography, and facility type. Participant demographics from trial and the National Cancer Database (NCDB) participants were compared using chi-squared goodness of fit and one-sample t-test where applicable. RESULTS: Of 50 CT groups identified, 42 (82%) studies reported mean or median age. Trial participants were younger compared to NCDB patients (P < .001 all studies). All but three trials had fewer female patients than NCDB (48.2% female, P < .001). Less than half the CT groups reported on race or ethnicity. Eighteen out of 22 trials (82%) had a smaller percentage of Black patients and 4 out of 8 (50%) trials had fewer Hispanic or Spanish origin patients than the NCDB. No CTs reported comorbidities, socioeconomic factors, or education. CT primary sites were largely at academic centers and in urban areas. CONCLUSION: The present study supports the need for improved demographic representation and transparency in rectal cancer clinical trials.

Disentangling Social Determinants of Health and Rurality in Head and Neck Cancer 2-Year Mortality.

Social determinants of health (SDoH) and rurality are known factors that may influence outcomes in head and neck squamous cell carcinoma (HNSCC). Patients residing in remote locations or those with multiple SDoH may encounter barriers to initial diagnosis, adherence to multidisciplinary treatments, and posttreatment surveillance, which may impact their overall survival. However, previous studies have shown mixed results associated with rural residence. The aim of this study is to identify the impact of rurality and SDoH on 2-year survival in HNSCC. The study was conducted using a Head and Neck Cancer Registry at a single institution from June 2018 through July 2022. Rurality, defined by US census scores, and individual measures of SDoH were used. Our results indicate that each additional adverse SDoH factor results in 1.5 times the odds of mortality at 2 years. Individualized measures of SDoH, rather than rurality alone, better reflect patient prognosis in HNSCC.

Quantifying Faculty Perception of Diversity, Equity, and Inclusion Within Academic Otolaryngology-Head and Neck Surgery Departments.

OBJECTIVE: Investigating faculty perceptions of diversity, equity, and inclusion (DEI) among academic otolaryngology programs. STUDY DESIGN: Quantitative survey. SETTING: Academic otolaryngology departments. METHODS: The DEI Inventory was developed by a multi-institutional health equity consortium and disseminated within 16 academic otolaryngology programs. The inventory consisted of 25 items graded on a 5-point Likert scale (strongly disagree to strongly agree), 2 yes/no questions, and 5 items reflecting overall DEI, stress, and burnout among academic otolaryngologists. Validated imposter phenomenon and personality trait measures were also included. RESULTS: The inventory received 158 (31.0%) partial and 111 (21.8%) full responses. No significant differences were identified in DEI scores by race. Compared to males, females reported lower scores on the overall DEI Inventory (3.6 vs 4.3, p < .001). Female respondents also reported greater levels of imposter phenomenon than their male counterparts (53.2 vs 47.5, p = .049). CONCLUSION: Preliminary responses to our DEI Inventory suggest that faculty perception of DEI is not impacted by race. Female faculty report considerably lower perceptions of DEI than their male counterparts and experience greater levels of imposter phenomenon. The results of the DEI Inventory can help departments design meaningful interventions to improve levels of DEI among faculty.

Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy: A Prospective Cohort Study.

Importance: Timely initiation of postoperative radiation therapy (PORT) is associated with reduced recurrence rates and improved overall survival in patients with head and neck squamous cell carcinoma (HNSCC). Measurement of the association of social-ecological variables with PORT delays is lacking. Objective: To assess individual and community-level factors associated with PORT delay among patients with HNSCC. Design, Setting, and Participants: This prospective cohort study carried out between September 2018 and June 2022 included adults with untreated HNSCC who were enrolled in a prospective registry at a single academic tertiary medical center. Demographic information and validated self-reported measures of health literacy were obtained at baseline visits. Clinical data were recorded, and participant addresses were used to calculate the area deprivation index (ADI), a measure of community-level social vulnerability. Participants receiving primary surgery and PORT were analyzed. Univariable and multivariable regression analysis was performed to identify risk factors for PORT delays. Exposures: Surgical treatment and PORT. Main Outcomes and Measures: The primary outcome was PORT initiation delay (>42 days from surgery). Risk of PORT initiation delay was evaluated using individual-level (demographic, health literacy, and clinical data) and community-level information (ADI and rural-urban continuum codes). Results: Of 171 patients, 104 patients (60.8%) had PORT delays. Mean (SD) age of participants was 61.0 (11.2) years, 161 were White (94.2%), and 105 were men (61.4%). Insurance was employer-based or public among 65 (38.5%) and 75 (44.4%) participants, respectively. Mean (SD) ADI (national percentile) was 60.2 (24.4), and 71 (41.8%) resided in rural communities. Tumor sites were most commonly oral cavity (123 [71.9%]), with 108 (63.5%) classified as stage 4 at presentation. On multivariable analysis, a model incorporating individual-level factors with health literacy in addition to community-level factors was most predictive of PORT delay (AOC= 0.78; R2, 0.18). Conclusions and Relevance: This cohort study provides a more comprehensive assessment of predictors of PORT delays that include health literacy and community-level measures. Predictive models that incorporate multilevel measures outperform models with individual-level factors alone and may guide precise interventions to decrease PORT delay for at-risk patients with HNSCC.

Loss to Follow-up in Head and Neck Cancer: A Systematic Review of Randomized Controlled Trials.

OBJECTIVE: To evaluate the reporting and rates of loss to follow-up (LTFU) in head and neck cancer (HNC) randomized controlled trials based in the United States. DATA SOURCES: Pubmed/MEDLINE, Cochrane, Scopus databases. REVIEW METHODS: A systematic review of titles in Pubmed/MEDLINE, Scopus, and Cochrane Library was performed. Inclusion criteria were US-based randomized controlled trials focused on the diagnosis, treatment, or prevention of HNC. Retrospective analyses and pilot studies were excluded. The mean age, patients randomized, publication details, trial sites, funding, and LTFU data were recorded. Reporting of participants through each stage of the trial was documented. Binary logistic regression was performed to evaluate associations between study characteristics and reporting LTFU. RESULTS: A total of 3255 titles were reviewed. Of these, 128 studies met the inclusion criteria for analysis. A total of 22,016 patients were randomized. The mean age of participants was 58.6 years. Overall, 35 studies (27.3%) reported LTFU, and the mean LTFU rate was 4.37%. With the exception of 2 statistical outliers, study characteristics including publication year, number of trial sites, journal discipline, funding source, and intervention type did not predict the odds of reporting LTFU. Compared to 95% of trials reporting participants at eligibility and 100% reporting randomization, only 47% and 57% reported on withdrawal and details of the analysis, respectively. CONCLUSION: The majority of clinical trials in HNC in the United States do not report LTFU, which inhibits the evaluation of attrition bias that may impact the interpretation of significant findings. Standardized reporting is needed to evaluate the generalizability of trial results to clinical practice.

Assessing the Risk of Adjuvant Radiotherapy Initiation Delays With Social Support Surveys.

OBJECTIVE: In patients with head and neck squamous cell carcinoma (HNSCC), initiating postoperative radiotherapy (PORT) greater than 42 days after surgery is associated with a higher risk of poor survival outcomes. Social support has been shown to modulate behaviors related to care-seeking and treatment adherence. In this study, we sought to determine the relationship between social support metrics and PORT delays. STUDY DESIGN: Prospective cohort study. SETTING: Single tertiary medical center. METHODS: Patients with HNSCC who underwent primary surgical excision requiring PORT were prospectively enrolled. Patient-perceived social support metrics were assessed using the Medical Outcomes Study Social Support Survey (MOS-SSS) at initial presurgical evaluation. Associations with PORT delays were evaluated via univariable and multivariable logistic regression analysis. RESULTS: A total of 111 patients met the inclusion criteria for the study. An additional 28 patients were recommended to receive PORT but did not initiate treatment and were included for secondary analysis. All four subscales of the MOS-SSS (positive social interaction, affectionate support, tangible support, and emotional/informational support) were significantly associated with PORT initiation delays on univariable analysis. On multivariable analysis, the overall MOS-SSS score (odds ratio [OR] 2.08, 1.15-4.35, p = .028) was significantly associated with PORT initiation delays. On secondary analysis, lower tangible support was associated with a lack of PORT initiation (OR 1.63, 1.05-2.54, p = .028). CONCLUSION: Social support metrics were significantly associated with PORT delays, which may help promote tighter scheduling and closer monitoring of high-risk patients.

Intraoperative Neural Response Telemetry and Auditory Outcomes in Pediatric Cochlear Implantation.

OBJECTIVE: To evaluate the relationship between intraoperative neural response telemetry (NRT) and postoperative auditory testing outcomes in children. STUDY DESIGN: Retrospective study. SETTING: Tertiary-care academic center. METHODS: Children who underwent cochlear implantation using the Cochlear Corporation device between 2010 and 2019 were included. Associations of average NRT and the slope of amplitude with postoperative auditory outcomes including functional auditory measure Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), and speech perception testing (consonant-nucleus-consonant [CNC], Pediatric AzBio [BABY BIO], Hearing In Noise Test [HINT], and Northwestern University Children's Perception of Speech [NU-CHIPS]), measured between 6 and 57 months after implantation, were assessed using Spearman's rank correlation (ρ). RESULTS: Thirty-eight patients (19 female, 19 male) and 54 ears were included. The median age of implantation was 20.6 months (range 9.6 months to 10.6 years). Eight (21%) children had neurologic disorders such as stroke, epilepsy, cerebral palsy, and other causes. Thirteen (34%) children had connexin mutations. Average NRT was not significantly correlated with postoperative auditory outcomes (IT-MAIS [ρ = -0.08, p = .74], CNC [ρ = 0.19, p = .32], BABY BIO [ρ = 0.21, p = .29], HINT [ρ = 0.05, p = .83]) and NU-CHIPS (ρ = 0.21, p = .28). The average slopes of amplitude and comfort level were not strongly correlated with any auditory outcomes (p > .05). CONCLUSIONS: Intraoperative NRT was not correlated with any postoperative functional auditory outcomes. Patient counseling should include discussions that a subpar intraoperative cochlear response does not preclude favorable speech and auditory outcomes.

Long-term trends in body mass index throughout upper airway stimulation treatment: does body mass index matter?

STUDY OBJECTIVES: Upper airway stimulation is a surgical option for patients with obstructive sleep apnea who fail other forms of noninvasive treatment. Current guidelines recommend a baseline body mass index (BMI) below 32 kg/m2 for eligibility. In this study, we identify trends in BMI before and after upper airway stimulation to characterize the influence of BMI on treatment success. METHODS: Patients underwent upper airway stimulation implantation between 2016 and 2021. Sleep study data were collected from preoperative and most recent postoperative sleep study. BMI data were collected and compared across the following time points: preoperative sleep study (BMI-1), initial surgeon consultation (BMI-2), surgery (BMI-3), titration polysomnogram (BMI-4), and second postoperative sleep study (BMI-5). Patients were categorized into groups (BMI ≥32 [BMI32], 25 ≤ BMI <32 [BMI25], BMI <25 [BMI18]) based BMI-1, and clinical outcomes were compared. RESULTS: 253 patients were included. The BMI32 group showed a significant decrease in BMI between BMI-1 and BMI-3 (33.9 vs 32.2; P < .001) and a significant increase in BMI between BMI-3 and BMI-5 (32.2 vs 33.0; P = .047). Apnea-hypopnea index improvement and treatment success rate were not significantly different between groups. On univariate and multivariable logistic regression, a lower BMI-5 was significantly predictive of treatment success (odds ratio: 0.88; 95% confidence interval: 0.79-0.97; P = .016). BMI-5 was also significantly associated with improvement in apnea-hypopnea index (P = .002). Other BMI time points were not associated with measures of treatment success. CONCLUSIONS: Reduced BMI after upper airway stimulation implantation, as opposed to baseline BMI, predicted treatment success. These findings may guide patient counseling, with implications for long-term adherence and therapy success. CITATION: Renslo B, Virgen CG, Sawaf T, et al. Long-term trends in body mass index throughout upper airway stimulation treatment: does body mass index matter? J Clin Sleep Med. 2023;19(6):1061-1071.

Team Consistency in Reducing Operative Time in Head and Neck Surgery with Microvascular Free Flap Reconstruction.

OBJECTIVE(S): To evaluate the impact of consistent surgical teams on procedure duration in head and neck free tissue transfer, and to evaluate the length of stay and readmission rates with consistent teams. METHODS: A retrospective chart review of head and neck microvascular reconstruction by a single surgeon between August 2017 and November 2021 was performed. Procedure duration, wound complications, length of stay, and 30-day readmissions were analyzed. One circulating nurse (CN) and surgical technologist (ST) were considered "consistent" due to their prior work with the primary surgeon. All others were considered "ad hoc." Teams were "Consistent CN + ST," "Consistent ST," "Consistent CN," or "Ad hoc." Procedure duration between groups was compared via analysis of variance. Multivariate linear regression was performed to predict procedure duration. RESULTS: A total of 135 patients were included. Age, sex, and American Society of Anesthesiologists status did not significantly differ across groups (p = 0.963; p = 0.467; p = 0.908, respectively). The mean procedure duration was 339.3 min and differed significantly across all groups (p = 0.006, Cohen d = 0.32). Compared to the Ad hoc group, consistent teams demonstrated significant reductions in mean procedure duration (Consistent CN + ST: 58.4 min, p = 0.001, Cohen d = 0.67; Consistent ST: 51.6 min, p = 0.013, Cohen d = 0.61; Consistent CN: 44.5 min, p = 0.031, Cohen d = 0.52). Controlling for other factors, the ad hoc team predicted increased procedure duration on multivariate analysis ( ß 57.38, 19.92-94.85, p < 0.003). Wound complications, length of stay, and readmission rates did not differ significantly across groups (p = 0.940; p = 0.174; p = 0.935, respectively). CONCLUSION: Consistent CN and ST improve operative efficiency in head and neck-free tissue transfer. Future studies may evaluate the impact of team consistency on complications, physician burnout, and health systems costs. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:2154-2159, 2023.

Association of Ear Anomalies and Hearing Loss Among Children With 22q11.2 Deletion Syndrome.

OBJECTIVE: To identify inner and middle ear anomalies in children with 22q11.2 deletion syndrome (22q11DS) and determine associations with hearing thresholds. STUDY DESIGN: Retrospective study. SETTING: Two tertiary care academic centers. METHODS: Children presenting with 22q11DS between 2010 and 2020 were included. Temporal bone imaging with computed tomography or magnetic resonance imaging was reviewed by 2 neuroradiologists. RESULTS: Twenty-two patients (12 female, 10 male) were identified. Forty-four ears were evaluated on imaging. There were 15 (34%) ears with abnormal semicircular canals, 14 (32%) with abnormal vestibules, 8 (18%) with abnormal ossicles, 6 (14%) with enlarged vestibular aqueducts, 4 (9.1%) with abnormal facial nerve canals, and 4 (9.1%) with cochlear anomalies. There were 25 ears with imaging and audiometric data. The median pure tone average (PTA) for ears with any structural abnormality was 41.0 dB, as compared with 28.5 dB for ears without any structural abnormality (P = .21). Of 23 ears with normal imaging, 6 (26%) had hearing loss in comparison with 13 (62%) of 21 ears with abnormalities (P = .02). Total number of anomalies per ear was positively correlated with PTA (Pearson correlation coefficient, R = 0.479, P = .01). PTA was significantly higher in patients with facial nerve canal anomalies (P = .002), vestibular aqueduct anomalies (P = .05), and vestibule anomalies (P = .02). CONCLUSIONS: Semicircular canal, ossicular, vestibular aqueduct, and vestibular anomalies were detected in children with 22q11DS, especially in the setting of hearing loss. Careful evaluation of anatomic anomalies is needed prior to surgical intervention in these patients.

Utility of intraoperative neural response telemetry in pediatric cochlear implants.

OBJECTIVE: The objective of this study is to evaluate the relationship between intraoperative neural response telemetry (NRT) and postoperative Threshold (T) and Comfort (C) levels and their correlation over time after cochlear implantation (CI). METHODS: A retrospective chart review was conducted of patients less than 18 years of age who had CI with a Cochlear™ device and NRT at an academic center from 2010 to 2019. Data collected included demographics, extrapolated NRT threshold (tNRT) and slope of amplitude for electrodes 1, 6/7, 11/12, 16, and 22, and postoperative T and C levels at initial activation and 1 month, 3 months, and 1 year post-activation. Associations between T and C levels and slope of amplitude or tNRT were assessed using Spearman's rank correlation. RESULTS: 39 patients (65 CIs) were included. Intraoperative tNRT correlated strongly with T and C levels at 1 month, 3 months, and 1 year post-activation on nearly all electrodes. Electrodes 6/7 and 11/12 at 3 months and electrodes 6/7 at 1 year did not correlate with T and C levels. There was no significant relationship between the slope of amplitude for nearly all electrodes and the T or C levels post-activation. CONCLUSION: NRT is invaluable in children, with significant correlation found between tNRT and T and C levels over time on nearly all electrodes. There are changes in T and C levels in electrodes 6/7 and 11/12 over time, and close surveillance is beneficial to tailor programming as needed.

The development of the object sequencing imitation task to measure working memory in preschoolers.

We developed a new object sequencing imitation (OSI) task for preschoolers. We parameterized the task to test the effects of working memory load in 56 3- to 5-year-old children in a museum. We tested individual groups of 3-, 4-, and 5-year-olds on both "low" (2- to 4-step) and "high" (3- to 5-step) memory load sequences on two variants of the task. The experimenter demonstrated each sequence three times, and children were given 3 trials to imitate the sequence, receiving feedback from the experimenter following each trial. Children were tested on an object that was functionally the same but perceptually different. All preschoolers performed significantly above baseline. We found a significant load effect, showing that performance decreased with increasing steps per sequence. There was no effect of age on performance, showing that leveling of the task across age was successful. Overall, the newly developed OSI task can test age- and load-related changes in working memory in 3- to 5-year-old children. The new OSI task will have utility in longitudinal studies and in studies where multiple trials are needed such as neuroimaging.

Incidence of synchronous malignancies found during triple endoscopy in head and neck cancer.

OBJECTIVES: To investigate the incidence of synchronous malignancies identified during triple endoscopy in patients with head and neck squamous cell carcinoma. METHODS: A retrospective chart review of patients from a tertiary academic medical center was performed. Patients with a primary head and neck squamous cell carcinoma who underwent triple endoscopy were included. Operative, radiographic, and pathology reports were reviewed to evaluate for the presence of synchronous malignancies in the aerodigestive tract diagnosed through endoscopy. Demographics, relevant medical history, including tobacco and alcohol use, and tumor characteristics were recorded. Univariate and multivariate regression analyses were conducted to assess for associations with synchronous malignancy on triple endoscopy. RESULTS: 215 patients were reviewed, 164 of which had a biopsy-positive head and neck squamous cell carcinoma and underwent triple endoscopy. Synchronous lesions were found in 8 patients (4.9%). Of the synchronous lesions, only two were identified on esophagoscopy and bronchoscopy; the remaining six were found on direct laryngoscopy. Clinical comorbidities including smoking and alcohol history, tumor p16 status, and tumor stage were not associated with presence of synchronous lesions. A positive synchronous lesion on positron emission tomography was significantly correlated with finding a synchronous lesion on triple endoscopy (p = 0.006). CONCLUSION: This study shows the incidence of synchronous lesions on triple endoscopy to be closer to 5%. While endoscopic examination can be useful in the anatomic characterization of head and neck malignancies, the low incidence of synchronous malignancies suggests that the need for triple endoscopy may be considered on a case-by-case basis.

Imaging in pediatric bilateral sensorineural hearing loss: Diagnostic yield with computed tomography versus magnetic resonance imaging.

OBJECTIVES: To evaluate the findings and compare the diagnostic yield of computed tomography (CT) versus magnetic resonance imaging (MRI) in children with bilateral sensorineural hearing loss (BSNHL). STUDY DESIGN: Multi-institutional retrospective review. SETTING: Three tertiary referral centers. METHODS: A multi-institutional retrospective chart review was performed in patients under the age of 18 years with BSNHL (diagnosis codes 389.00-389.22) who underwent both CT and MRI from 2010 to 2012. An abnormal imaging finding was defined as an abnormality of the cochleovestibular or central nervous system known to directly correlate with sensorineural hearing loss. Diagnostic yield of CT versus MRI was compared by McNemar's test. RESULTS: Of 2081 charts reviewed, 313 patients met inclusion criteria. The diagnostic yield of CT and MRI were 25% and 18%, respectively. Approximately one-quarter of patients had an abnormal finding on CT or MRI. The concordance rate was 92%. CT was more likely to yield an abnormal finding versus MRI (p-value = 0.0001). The most common findings on CT were cochlear and semicircular canal abnormalities. On MRI, the most common findings were cochlear nerve aplasia/hypoplasia and semicircular canal abnormalities. CONCLUSIONS: This study evaluates and directly compares the diagnostic yield of CT versus MRI for pediatric BSNHL. While both modalities have important and often complementary diagnostic utility, CT had superior diagnostic yield in identifying abnormalities associated with BSNHL.