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
Auricular Hematoma
Dr. Md. Harun Ar Rashid, MPH, MD, PhD, is a highly respected medical specialist celebrated for his exceptional clinical expertise and unwavering commitment to patient care. With advanced qualifications including MPH, MD, and PhD, he integrates cutting-edge research with a compassionate approach to medicine, ensuring that every patient receives personalized and effective treatment. His extensive training and hands-on experience enable him to diagnose complex conditions accurately and develop innovative treatment strategies tailored to individual needs. In addition to his clinical practice, Dr. Harun Ar Rashid is dedicated to medical education and research, writing and inventory creative thinking, innovative idea, critical care managementing make in his community to outreach, often participating in initiatives that promote health awareness and advance medical knowledge. His career is a testament to the high standards represented by his credentials, and he continues to contribute significantly to his field, driving improvements in both patient outcomes and healthcare practices.
