Assessment of the Head, Eyes, Ears, Throat and Neck (HEENT)

• Inspect the Head o Normocephalic
 Microcephalic  abnormally small head
 Macrocephaly  abnormally large head o Temporal artery
 Arteritis o Temporomandibular joint o Scalp
 Inspect for lesions, scaling, tenderness, and masses o Inspect the face
 Symmetry
• Central brain lesion (CVA)
• CN VII damage e.g. Bell’s palsy
 Facial expression – anxiety, excessive smiling
 Abnormal facial structure
• Exophthalmus, changes in skin color
• Edema – periorbital or across the cheeks
• Tics
• Excessive blinking
• Grinding of the jaw
 Compare Eyebrows, nasolabial folds, sides of mouth

o Inspect the Neck
 Symmetry – head position midline
 Head tilt in muscular spasm
 Trachea in midline
 ROM
• Chin to chest
• Head to shoulder
• Turn head to R and L (say “no”). o Person turns shoulders instead of neck
• Note pain, ratchety movement, limited ROM due to arthritis or inflammation of neck muscles o Lymph nodes - Note:
 Size and shape
 Delimitation
 Mobility
 Consistency – hard or soft
 Tenderness (with acute infection)
 Lymph Nodes
• Preauricular:
• Posterior auricular
• Occipital: base of the skull
• Submental
• Submandibular: halfway between the angle and the tip of the mandible
• Jugulodigastric (tonsilar)
• Superficial cervical
• Deep cervical
• Posterior cervical
• Supraclavicular o Thyroid Gland
 Goiter
• Inspect the Eyes o Inspect External Ocular Structures o Facial expression – squinting o Eyebrows
 Move symmetrically
 No scaling or lesions o Eyelids/eyelashes
 Eyelids meet together
 The palpebral fissure
 Eyelashes should be evenly distributed
 Ptosis – drooping of upper lid
 Skin without redness, discharge or lesions o Eyeballs
 Exophthalmos (protruding eyes)
 Enophthalmos (sunken eyes) o Conjunctiva and sclera
 Conjunctiva - normal color – pink over lower lids, white over sclera
 Sclera – china white o Assess for drainage, swelling, redness, asymmetry & lesions
 External & Internal hordeolum (stye)
 Ectropion Conjuctivitis
 Arcus Senilis Cataract o PERRLA
 Contralateral Pupil Constriction
• Inspect the Ear o Inspection of the Ear o Ears should be equal size
 Microtia – ears smaller than 4 cm vertically
 Macrotia – ears larger than 10 cm vertically o Skin intact, same color as face, intact
 Tenderness
 Move pinna and push on tragus
 Assess for lesions, swelling, drainage o Tympanic Membrane
 Otoscope – just for fun
 Note any redness, swelling, discharge, foreign bodies
 The tympanic membrane, or eardrum  translucent with a pearly gray color.
• Ear drum