HEENT Notes

Thyroid Gland: Internal structures related to eye function.
Fris: Refers to the color of the eyes.
Muscles: Contribute to accommodation (the ability of the eye to focus on near and distant objects).

Retina: An extension of the optic nerve and responsible for receiving light and converting it into neural signals.
Sclera: The white portion of the eye which provides structural support.
Cornea: Offers protection to the inner structures of the eye.
Aqueous Humor: The transparent liquid inside the eye, which helps maintain intraocular pressure and provides nutrients to the eye.

Tragus: Cartilage that protects the ear canal.
External Auditory Canal: Sound waves travel through this canal to reach the tympanic membrane (eardrum).
Ear Wax: Found within the external auditory canal, aids in sound conduction.

Middle Ear: Contains ossicles (small bones) that transfer sound vibrations to the cochlea and then to Cranial Nerve VIII (CN VIII). Sound is interpreted in the temporal lobe.
- Ossicles: Include the malleus, incus (smallest bones in the body), and stapes.
- Tympanic Membrane: Separates the external ear from the middle ear.
- Eustachian Tube: Connects the nasopharynx to the middle ear, crucial for maintaining pressure balance, humidification, and sound resonance.

Anatomy: Consists primarily of bone and cartilage, contributing to the structure and function related to olfaction (odor identification):
- Maintains proper airflow through the nasal passages.
Turbinate: Increases the surface area of the nasal cavity for better humidification and filtration of inhaled air.

Tongue: Should be pink and moist; a muscle central to taste and swallowing.
Permanent Teeth: Children have a total of 20 teeth before acquiring additional permanent teeth, including wisdom teeth.
Frenulum: A small fold of tissue that anchors the tongue.
- Fontanels: Spaces between the skull bones in infants, which close at specific ages (e.g., posterior closes within 1-3 months, anterior between 9-24 months).
Tonsils: Lymph nodes that can become enlarged usually indicating infection, typically develop until age 5.

Infants are typically farsighted until age 8 and cannot see colors until around 8 months.
Regular dental visits are important for preventing childhood dental issues.

Eustachian Tubes: More horizontal in children, increasing the risk of ear infections.
Symptoms & Indications:
- Recurrent sore throats and congestion.
- Medications and interventions may include dental surgeries and thyroid assessments.

Head trauma, concussions, headaches, snoring, seizures, dry eyes, thyroid disease, nasal stuffiness & surgeries.
Eye trauma, chronic illnesses (such as diabetes), changes in vision, and overall health history.
Document instances of epistaxis (nosebleeds), dental issues, vision changes, thyroid size changes, and any familial histories of disease.

Older adults may experience a decline in hearing, headaches, taste issues, and increased rates of conditions such as glaucoma, cataracts, and macular degeneration.
Environmental and lifestyle factors (e.g., alcohol and tobacco use) may elevate the risk of oral cancer.

Inspect facial symmetry, any tics, spasms, and palpitations of the thyroid.
Assess oral hygiene and dental health, including lesions, cavities, and signs of cancer in oral mucosa.

Rosenbaum Pocket Vision Screener: Tests near vision; hold at 14 inches.
Snellen Chart: Tests distance vision; includes specific identification of letters; record using a fraction format (e.g., numerator = distance patient is from chart, denominator = standard distance).
Assess for any discharge, eye alignment, and movement.

Weber Test: Use a tuning fork to assess lateralization of sound.
Rinne Test: Compares air conduction to bone conduction of sound using a tuning fork.
Expected ration should be 2:1 for air to bone conduction.

Inspect nasal passages for structural abnormalities such as deviated septum or polyps, using proper lighting techniques.
Check for swollen turbinates or signs of infection.

Identify abnormalities in teeth and gums, noting conditions like gingivitis, hyperplasia, cancer signs, or malocclusions.
Document any significant findings for further evaluation.

Unexpected findings should be noted for appropriate referrals or treatment. Report any additional symptoms relating to energy levels, health history that could influence HEENT conditions.
Keep a detailed account of throughout physical examination, focusing on variations from normal findings to support clinical reasonings.