HEENT ( Head, Eyes, Ear, Nose & Throat)

The Head
1) Hair: note its quantity, distribution, texture, and pattern of loss.
2) Scalp: part hair in several places and look for scaliness, lumps, and lesions.
3) Skull: observe the general contour and size of the skull. Note deformities, lumps, depression,
and tenderness.
4) Face: note facial expression and contour; observe for asymmetry, involuntary movements,
edema, and masses.
5) Skin: note color, pigmentation, hair distribution, and lesions.
The Eyes:
1) Visual acuity: use Snellen eye chart, position patient 20 feet from the chart, ask the patient to
cover one eye, and read the smallest print possible (20/220 means, at 20 feet the patient can
read print that a person with normal vision could read at 200 feet).
2) Visual fields: ask pt. to look with both eyes into yours, place your hands about 2 feet apart,
lateral to the patient’s ears. Slowly move the wiggling fingers of both your hands along the
sides.
3) Position and alignment of the eyes: survey the eyes for position and alignment.
4) Eyebrows: note quantity and distribution.
5) Eyelids: note edema, the color of the lids, lesions.
6) Lacrimal Apparatus: assess for lachrymal sac swelling.
7) Conjunctiva and Sclera: ask the patient to look up as you lower both lids with your thumb.
8) Pupils: assess size, shape, and symmetry, test light reaction.
9) Ocular movement: six cardinal direction of gaze, use H.
You may have heard your eye doctor mention “PERRLA” when discussing testing your pupils.
PERRLA is an acronym used to document a common pupillary response test. This test is used to
check the appearance and function of your pupils. The information can help your doctor
diagnose several conditions, from glaucoma to neurological diseases.

PERRLA is an acronym that helps doctors remember what to check for when examining your
pupils. It stands for:

 Pupils. The pupils are in the center of the iris, which is the colored part of your eye. They
control how much light enters the eye by shrinking and widening.

 Equal. Your pupils should be the same size. If one is larger than the other, your doctor will want
to do some additional testing to figure out why.

 Round. Pupils should also be perfectly round, so your doctor will check them for any unusual
shapes or uneven borders.
 Reactive to. Your pupils react to your surroundings to control how much light enters your eyes.
This step reminds your doctor to check your pupils’ reactions to the next two items in the
acronym.

 Light. When your doctor shines a light in your eyes, your pupils should get smaller. If they don’t,
there could be a problem affecting your eyes.

 Accommodation. Accommodation refers to your eyes’ ability to see things that are both close
up and far away. If your pupils are nonreactive to accommodation, it means they don’t adjust
when you try to shift your focus to an object in the distance or near your face.

You can also think of PERRLA as a sentence. Pupils are equal, round, and reactive to light

and accommodation.

The Ears:
1) The auricle: note deformities, lumps or lesions.
2) Auditory acuity: ask pt. to occlude one ear, standing behind the pt. 1-2 feet away and
whisper softly the words “nine four” towards the unoccluded ear.
3) Air and bone conduction: assess the conductive or sensorineural loss. Use a tuning fork,
strike it against your PALM of the hand and place it firmly on top of the patient’s head (Weber’s
test). Ask the patient where the sound is heard (should be equal). Rinne test: place the base of
the tuning fork on the mastoid bones, behind the ear and level with the canal, then when the
patient can no longer hear the sound, quickly place the fork close to the ear canal and ascertain
that the sound can be heard, conduction is greater through the air than bone.
The Nose and Paranasal Sinuses:
Inspect the anterior and inferior surface of the nose. Gentle pressure on the tip of the nose
with your thumb usually widens the nostrils and with a penlight examines each vestibule. Note
any asymmetry or deformities, swelling, bleeding, or exudates.
The Mouth and Pharynx
1) The lips: observe color and moisture and note any lumps, ulcers and cracking.
2) The oral mucosa: assess for moisture.
3) The gums and teeth: note the color of the gums, normally pink. Inspect teeth; note any
missing, discolored or normally positioned tooth.
4) The Tongue: note the color and texture of the tongue.
5) The Pharynx: ask patient to say “ah” with tongue not protruded (cranial nerve X).