HEENT Exam Notes

HEENT Exam Overview

• The HEENT exam stands for Head, Ears, Eyes, Nose, and Throat; alternatively called an ENT exam.

  • Full screening is conducted first, followed by special tests that are not necessary for every patient.

General Preparation

• Hand Hygiene: Always wash hands before beginning the examination.

• Otoscope Preparation:

  • Ensure the otoscope is properly assembled with a clean light and tip.

  • Check the function of the light.

Initial Examination Steps

• Inspection and Palpation:

  • Begin with general inspection and palpation.

  • Focus on the head, neck, and related structures.

  • Palpate for rashes, bruises, or abnormal moles.

  • Symmetry of the scalp should be noted, including presence of flat spots or development irregularities.

  • Detailed palpation may include checking for suspected fractures (e.g., broken nose).

The Ear Examination

• Method:

  • Start the ear examination often as a habit.

  • Proper bracing while using the otoscope is crucial:

    • Support both hands to avoid accidental injury.

    • Pull the ear out and up to open the canal.

    • Place the otoscope behind the tragus and adjust to visualize the ear canal and tympanic membrane.

• Important Points:

  • Practice different methods of bracing and positioning the otoscope.

The Eye Examination

• Pupil Check:

  • Instruct the patient to focus straight ahead to allow for a larger pupil.

  • Flash light in each pupil to observe the direct and consensual reaction.

• Other tests:

  • Test for extraocular motions by having the patient follow the examiner's finger in an H pattern. Look for convergence and accommodation during this check.

The Nose Examination

• Otoscope Use:

  • Use a clean tip and brace your hand on the patient’s cheek.

  • Insert the ear tip gently into the nostril and adjust for better view of the nasal mucosa.

The Oral Examination

• Equipment Needed:

  • Light source

  • Tongue blade

  • Patient vocalization of "ah"

• Steps:

  • Ask the patient to open their mouth wide

  • Shine the light and observe the oral cavity while using the tongue blade gently without causing a gag reflex.

  • Look for abnormalities in the roof of the mouth, buccal mucosa, and dentition.

  • The tongue can be checked for lesions or abnormalities as well.

Lymph Node Palpation

• Nodes to Palpate:

  • Posterior Auricular

  • Anterior Auricular

  • Cervical chain (by sternocleidomastoid)

  • Submandibular

  • Submental

  • Supraclavicular

• Technique: Use gentle pressure and both thumbs to palpate the lymph nodes, remaining mindful of the surrounding anatomy.

Thyroid Examination

• Location:

  • Thyroid is located just above the clavicle, not on the neck.

• Technique:

  • Palpate from behind using the fingers wrapped around the midline of the neck for symmetry and consistency of the gland.

  • Ask the patient to swallow to help assess for nodules or asymmetries in the gland.

General Notes on Examination

• Procedure:

  • After completing the initial visual and palpation examinations, perform:

    • Palpation of sinuses by manual pressure. Assess frontal and maxillary sinuses.

    • Transillumination specifically for the maxillary sinus.

    • Hearing Assessment: Use a simple screening method where the patient closes their eyes and reports sound perception in each ear while the examiner moves hands or uses a tuning fork as described.

    • Weber and Rinne tests for further evaluation of hearing:

      • Weber Test: Strike tuning fork and place in center, asking if it is heard equally in both ears.

      • Rinne Test: Compare bone conduction (on mastoid process) versus air conduction (in front of the ear) to confirm normal air conduction should be better.

Additional Techniques

• Insufflation: Perform insufflation by creating a puff of air against the tympanic membrane to assess for movement indicating possible effusion.

• Peripheral Vision Fields Testing: Have the patient focus ahead and test peripheral fields as they report seeing the examiner's fingers in their field of vision.

• Visual Acuity Testing: Use a vision chart (Snellen chart) to assess visual acuity at specified distances with each eye individually and together.

• Special Tests: Only administer if indicated by patient presentation, complaints, or signs during the screening examination.

Conclusion

• The HEENT exam encompasses a thorough investigation of the head, eyes, ears, nose, and throat, with specific techniques tailored to ensure accurate and reliable assessments of potential abnormalities. Practitioners must be comfortable with various bracing methods, inspection techniques, and patient engagement throughout the examination process.