HEENT stands for “head, eyes, ears, nose, and throat.” If someone is experiencing symptoms that affect those areas, such as sneezing, congestion, and a sore throat, they’ll likely receive a HEENT examination. A HEENT examination is a portion of a physical examination that principally concerns the head, eyes, ears, nose, and throat. The six examination methods used in a general physical exam include inspection, auscultation, palpation, percussion, mensuration, and manipulation. Documenting a normal exam of the head, eyes, ears, nose, and throat should look something along the lines of the following: Head – The head is normocephalic and atraumatic without tenderness, visible or palpable masses, depressions, or scarring. Hair is of normal texture and evenly distributed.
HEENOT = head, ears, eyes, nose, oral, throat examination; HEENT = head, ears, eyes, nose, and throat examination. The oral examination includes an examination of the teeth, gums, mucosa, tongue, and palate. A comprehensive physical exam is sometimes referred to as an executive physical. This exam includes laboratory tests, pulmonary function testing, chest x-rays, audiograms, EKGs, full-body CAT scans, heart stress tests, mammograms or prostate exams, and a urinalysis
Inspection
- Skin
- Color: erythema, ecchymosis, white, black
- Trophic changes (altered hair growth, sweat production)
- Scars
- Swelling
- Muscle tone: atrophy, hypertrophy
- Deformity: asymmetry, rotation, amputation
- Face should be symmetric
Palpation
- Palpate for
- Effusion
- Clicking
- Snapping
- Crepitus
- Tenderness
- Temperature
- Masses
Head and Face
- General
- Gross inspection
- Palpate scalp
- Points of interest
- Racoon eyes
- Battle sign
- Hemotympanum
- CSF Otorrhea
- CSF Rhinorrhea
- Mastoid process
- Temporomandibular Joint
Eyes
- General
- External eye (conjunctiva, sclera, pupil, iris, eyelids, lacrimal ducts, etc)
- Inspect for symmetry of pupils, eyelids
- Extraocular Movements/Near Response
- Pupillary response
- Consider testing
- Visual Acuity
- Visual Fields
- Fundoscopy (Ophthalmoscopy
- Manometry (testing pressure)
- Fluorescein stain with woods lamp
- Slit lamp
- Ultrasound of the Eye
Ears
- External ear
- Otoscopy including
- External auditory canal
- Tympanic Membrane
- Consider
- Hearing acuity
- Rinnes Test
- Webers Test
Nose
- External nose inspection
- Otoscopy to evaluate nasal cavity including septum, turbinates
- Palpation of sinuses (frontal, maxillary)
Oropharynx
- Dentition
- Tongue
- Hard and soft palate
- Uvula, tonsils
Cranial Nerves
- CN I (Olfactory)
- Smell (not routinely tested)
- Can test with strong smells such as lemon, peppermint
- CN II (Optic)
- Pupil size, shape and symmetry
- Visual fields by assessing 4 quadrants in each eye
- Visual acuity using Snellen chart
- Direct pupillary reflex (shine light in eye, look for ipsilateral restriction)
- Consensual pupillary reflex (shine light in eye, look for contralateral restriction)
- Accommodation reflex (switch from near object to close object)
- Assess color using Ishihara plates
- CN III, IV, VI (Oculomotor, Trochlear, Abducens)
- Eyelids: look for normal, symmetric movement
- Pupillary light reflex
- Accommodation
- Extraocular movement tested in all planes (classically with movement in an H pattern)
- CN V (Trigeminal)
- V1: forehead
- V2: cheek
- V3: lower mandible
- Muscles of mastication (open and close mouth against resistance)
- CN VII (Facial)
- Symmetry
- Rise eyebrows
- Close eyes tight
- Blow out cheeks
- Smile
- CN VIII (Vestibulocochlear)
- Sound in each ear (can rub fingers together)
- Rinnes Test
- Webers Test
- Balance testing (needs to be updated)
- CN IX, X (Glossopharyngeal, Vagus)
- Cough or swallow
- Open and say “ahhh”
- CN XI (Accessory)
- Turn head (Sternocleidomastoid)
- Shrug shoulders (Trapezius)
- CN XII (Hypoglossal)
- Open mouth
- Stick tongue out and move side to side
