Assessment of the Head, Eyes, Ears, Throat and Neck (heent)



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Assessment of the Head, Eyes, Ears, Throat and Neck (HEENT)

  • Inspect the Head

    • Normocephalic

      • Microcephalic  abnormally small head

      • Macrocephaly  abnormally large head

    • Temporal artery

      • Arteritis

    • Temporomandibular joint

    • Scalp

    • Inspect the face

      • Symmetry

        • Central brain lesion (CVA)

        • CN VII damage e.g. Bell’s palsy

      • Facial expression – anxiety, excessive smiling

      • Abnormal facial structure

        • Exophthalmus, changes in skin color

        • Edema – periorbital or across the cheeks

        • Tics

        • Excessive blinking

        • Grinding of the jaw

      • Compare Eyebrows, nasolabial folds, sides of mouth



    • Inspect the Neck

      • Symmetry – head position midline

      • Head tilt in muscular spasm

      • Trachea in midline

      • ROM

        • Chin to chest

        • Head to shoulder

        • Turn head to R and L (say “no”).

          • Person turns shoulders instead of neck

        • Note pain, ratchety movement, limited ROM due to arthritis or inflammation of neck muscles

    • Lymph nodes - Note:

      • Size and shape

      • Delimitation

      • Mobility

      • Consistency – hard or soft

      • Tenderness (with acute infection)

      • Lymph Nodes

        • Preauricular:

        • Posterior auricular

        • Occipital: base of the skull

        • Submental

        • Submandibular: halfway between the angle and the tip of the mandible

        • Jugulodigastric (tonsilar)

        • Superficial cervical

        • Deep cervical

        • Posterior cervical

        • Supraclavicular

    • Thyroid Gland

      • Goiter

  • Inspect the Eyes

    • Inspect External Ocular Structures

    • Facial expression – squinting

    • Eyebrows

    • Eyelids/eyelashes

      • Eyelids meet together

      • The palpebral fissure

      • Eyelashes should be evenly distributed

      • Ptosis – drooping of upper lid

      • Skin without redness, discharge or lesions

    • Eyeballs

      • Exophthalmos (protruding eyes)

      • Enophthalmos (sunken eyes)

    • Conjunctiva and sclera

      • Conjunctiva - normal color – pink over lower lids, white over sclera

      • Sclera – china white

    • Assess for drainage, swelling, redness, asymmetry & lesions

      • External & Internal hordeolum (stye)

      • Ectropion Conjuctivitis

      • Arcus Senilis Cataract

    • PERRLA

      • Contralateral Pupil Constriction

  • Inspect the Ear

    • Inspection of the Ear

    • Ears should be equal size

      • Microtia – ears smaller than 4 cm vertically

      • Macrotia – ears larger than 10 cm vertically

    • Skin intact, same color as face, intact

    • Tympanic Membrane

      • Otoscope – just for fun

      • Note any redness, swelling, discharge, foreign bodies

      • The tympanic membrane, or eardrum  translucent with a pearly gray color.

        • Ear drum should be flat and intact

  • Inspection of Nose, Mouth and Throat

    • Eternal nose

      • Symmetric, midline

      • No inflammation

      • Test for patency

    • Palpate sinuses

    • Nose

      • Assess for lesions, swelling, symmetry, discharge

    • Mouth

      • Assess moisture, lesions, swelling, drainage, teeth and gums

      • Lips – color, moisture, cracking (Cheilitis) or lesions

        • Retract lips and note inner surface

      • Teeth and gums

        • An adult mouth has 32 teeth

        • Diseased, missing, loose or abnormally positioned teeth

        • Decayed teeth  caries

        • Gingival hypertrophy

        • Bleeding gums

      • Tongue

        • Pink and even

        • Dorsal surface rough with papillae

        • Thin white coating

        • Ask pt to touch tongue to roof of mouth

          • Ventral surface should be smooth, glistening, showing veins

        • Saliva is present

        • Enlarged tongue abnormal

      • Mouth

        • Dry mouth – dehydration

        • Excessive drooling

        • Look for lesions e.g. canker sores, white patches (thrush) (malignancies)

      • Uvula

    • Throat

      • Inspect for lesions

      • Tonsils

        • Acute infection

        • White membrane covering tonsils  mononucleosis, leukemia, diphtheria

        • Enlargement; Acute infection, 2+, 3+, or 4+

          • 1+ - visible

          • 2+ halfway between tonsillar pillars

          • 3+ touching uvula

          • 4+ touching each other


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