The objective was to compare the diagnostic and therapeutic yield of neck imaging studies ordered by otolaryngologists (OHNS) compared with non-OHNS clinicians and identify factors associated with higher imaging value in adult neck mass workup.Retrospective chart review was conducted on a cohort of patients who underwent neck mass imaging (computed tomography, magnetic resonance imaging, or ultrasound) from 2021-2022. Imaging studies for suspected thyroid masses, incidental findings, or surveillance of known masses were excluded. The authors analyzed the impact of clinician specialty and preimaging workup (physical examination, flexible nasopharyngolaryngoscopy, point-of-care ultrasound) on diagnostic yield.Imaging ordered by OHNS had a higher diagnostic yield than imaging by non-OHNS clinicians (78.6% vs 52.3%, P < .001). In contrast, lack of physical examination reduced yield to 42.4%. OHNS-ordered imaging also had higher therapeutic yield (45.9% vs 29.5%, P = .0437) and required less repeat imaging. Incidental findings were common (14%), with no difference between ordering specialties, and led to downstream testing in 59% of cases, with 1 case of papillary thyroid cancer.A triage model favoring initial OHNS consultation may reduce unnecessary imaging, associated costs, and patient burden.Imaging for adult neck masses ordered by OHNS clinicians was associated with significantly higher diagnostic and therapeutic yield. Preimaging evaluation, including flexible nasopharyngolaryngoscopy and point-of-care ultrasound, showed a further improvement in yield. These findings suggest OHNS evaluation prior to formal neck imaging may reduce unnecessary imaging studies.