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Objectives/Hypothesis: To identify the imaging characteristics associated with better hearing outcomes found in cochleovestibular nerve (CVN) abnormalities treated with hearing aids and/or cochlear implantation (CI). Study Design: Retrospective review. Methods: A retrospective review was undertaken of 69 ears with CVN abnormalities seen on magnetic resonance imaging (MRI) treated at a tertiary referral academic center analyzing the clinical features, imaging characteristics, and hearing data. We searched for associations among the hearing and imaging data, hypothesizing that the imaging data was not a good indicator of hearing function. Results: In univariable analysis of all those who underwent aided testing (hearing aid and CI), health status (P =.016), internal auditory canal (IAC) midpoint diameter (P <.001), and number of nerves in the IAC (P <.001) were predictors of positive hearing outcome. Modiolar abnormalities, cochlear aperture diameter, cochlear malformations, vestibular malformations, and nerves in the cerebellar cistern did not predict hearing outcome (P =.79,.18,.59,.09,.17, respectively). For patients who received CI, health status (P =.018), IAC midpoint (P =.024), and number of nerves in the IAC (P =.038) were significant. When controlling for health status, IAC midpoint diameter (P <.001) and number of nerves in the IAC (P <.001) remained significant. In our cohort, one out of the eight ears (13%) with Birman class 0 or 1 exhibited responses to sound compared to nine out of 13 ears (70%) with Birman class 2–4. Conclusions: Current imaging modalities cannot accurately depict the status of the cochleovestibular nerve or predict a child's benefit with a CI. Cochlear implantation should be considered in children with abnormal cochleovestibular nerves. Level of Evidence: 3 Laryngoscope, 132:S1–S15, 2022 [ABSTRACT FROM AUTHOR]