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

Inspect the Head

o Normocephalic
Microcephalic abnormally small head
Macrocephaly abnormally large head
o Temporal artery
Arteritis
o Temporomandibular joint
o Scalp
Inspect for lesions, scaling, tenderness, and masses
o Inspect the face
Symmetry
Central brain lesion (CVA)
CN VII damage e.g. Bells 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
o

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).
o 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
o Thyroid Gland
Goiter
Inspect the Eyes
o Inspect External Ocular Structures
o Facial expression squinting
o Eyebrows
Move symmetrically
No scaling or lesions
o Eyelids/eyelashes
Eyelids meet together
The palpebral fissure
Eyelashes should be evenly distributed
Ptosis drooping of upper lid
Skin without redness, discharge or lesions
o Eyeballs
Exophthalmos (protruding eyes)
Enophthalmos (sunken eyes)
o Conjunctiva and sclera
Conjunctiva - normal color pink over lower lids, white over sclera
Sclera china white
o Assess for drainage, swelling, redness, asymmetry & lesions
External & Internal hordeolum (stye)
Ectropion
Conjuctivitis
Arcus Senilis
Cataract
o PERRLA
Contralateral Pupil Constriction
Inspect the Ear
o Inspection of the Ear
o Ears should be equal size
Microtia ears smaller than 4 cm vertically
Macrotia ears larger than 10 cm vertically
o Skin intact, same color as face, intact
Tenderness
Move pinna and push on tragus
Assess for lesions, swelling, drainage
o 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
o Eternal nose
Symmetric, midline
No inflammation
Test for patency
o Palpate sinuses

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Nose

Mouth

Over frontal sinuses below eyebrows

Over maxillary sinuses below cheekbones
Assess for lesions, swelling, symmetry, discharge
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
o Ventral surface should be smooth, glistening, showing veins
Saliva is present
Enlarged tongue abnormal
o Mental retardation, hypothyroidism, acromegaly
Mouth
Dry mouth dehydration
Excessive drooling
Look for lesions e.g. canker sores, white patches (thrush) (malignancies)
Uvula
Ask person to say aahh
o Soft palate and uvula rise in the midline (CN X)

Throat
Inspect for lesions
Tonsils
Acute infection
White membrane covering tonsils mononucleosis, leukemia, diphtheria
Enlargement; Acute infection, 2+, 3+, or 4+
o 1+ - visible
o 2+ halfway between tonsillar pillars
o 3+ touching uvula
o 4+ touching each other