The HEENT exam is a foundational part of the physical examination, assessing the head, face, and neck. This focused assessment is frequently performed during routine check-ups or when specific symptoms arise. It evaluates structures housing the primary sensory organs and the initial entry points for air and food. By systematically inspecting and palpating these areas, a healthcare provider gathers important information about a patient’s neurological function, immune status, and localized disease. The findings often serve as an initial screening tool, guiding the clinician toward potential diagnoses or the need for further specialized testing.
Understanding the Acronym and Scope
The acronym HEENT stands for Head, Eyes, Ears, Nose, and Throat. This systematic assessment evaluates structures related to the body’s major sensory and respiratory systems, including sight, hearing, and smell. It focuses on structures responsible for the body’s interaction with the external environment. The scope often extends to include the neck, encompassing the thyroid gland and the extensive lymphatic system. This makes it a comprehensive check for local or systemic illness, providing valuable clues regarding conditions such as infection, inflammation, trauma, and neurological impairment.
The Head and Neck Examination
Head
The head examination begins with inspecting the scalp and face, noting symmetry, skin condition, hair distribution, and signs of trauma or lesions. Palpation involves feeling the scalp for masses, tenderness, or depressions in the skull. The temporomandibular joint (TMJ) is assessed by asking the patient to open and close the mouth, checking for smooth movement, tenderness, or clicking sounds (crepitus).
Neck and Throat
The neck component focuses on the lymphatic system and the thyroid gland. The clinician systematically palpates multiple chains of lymph nodes, feeling for enlargement or tenderness that might indicate infection or malignancy. These chains include:
- Submental
- Submandibular
- Preauricular
- Postauricular
- Cervical
The thyroid gland is inspected and palpated for size, shape, and texture, often while the patient swallows water to observe its upward movement. The pharynx and oral cavity are assessed using a penlight and a tongue depressor to inspect the tonsils, posterior pharynx, and mucosa for redness, swelling, or exudates. Observing the soft palate and uvula elevation when the patient says “Aah” checks for symmetrical movement, which indicates cranial nerve function.
Assessing the Sensory Organs: Eyes, Ears, and Nose
Eyes
The eye assessment begins with checking visual acuity and examining external structures for redness, discharge, or lid drooping (ptosis). A specialized check assesses the pupils using the acronym PERRLA:
- Pupils
- Equal
- Round
- Reactive to Light
- Accommodation
This test evaluates the health of the nervous system pathways controlling vision by checking pupillary constriction and the ability to adjust focus on near objects. The examination also includes checking extraocular movements (EOMs) by having the patient follow an object in an ‘H’ pattern to test eye muscle control. A fundoscopic exam may be performed using an ophthalmoscope to view the retina, optic nerve, and blood vessels, providing insights into conditions like hypertension or diabetes.
Ears
The external ear structure is inspected for lesions before the clinician uses an otoscope to examine the ear canal. The otoscope provides magnification and light to assess the external auditory canal for cerumen or inflammation. It is used to visualize the tympanic membrane (eardrum). A healthy eardrum is typically translucent and pearly gray, often showing a visible “cone of light” reflection. In some cases, a pneumatic otoscope is used to puff air against the eardrum to check its mobility. This mobility check helps detect fluid accumulation in the middle ear space.
Nose
The nasal exam typically employs an otoscope or nasal speculum to inspect the internal nasal passages. The clinician checks the color and hydration of the nasal mucosa, which should be pink and moist, and looks for swelling of the turbinates or the presence of discharge. The nasal septum is specifically examined for deviation, which can obstruct airflow. The frontal and maxillary sinuses are also gently palpated to check for tenderness. Tenderness in these air-filled cavities may suggest inflammation or infection.