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HEENT Study Guide
1. Anatomy & Physiology of the HEENT System
Head: Houses brain; supported by skull bones (frontal, parietal, temporal, occipital). Facial muscles (CN VII) enable expression; CN V provides sensation. Eyes: External structures: eyelids, conjunctiva, sclera, cornea, lacrimal apparatus. Internal structures: iris, pupil, lens, retina, optic disc, vessels, macula. Cranial nerves: CN II: Vision CN III, IV, VI: Extraocular movements Pupil function: PERRLA (Pupils Equal, Round, Reactive to Light and Accommodation). Ears: External: auricle, canal. Middle: tympanic membrane, ossicles (malleus, incus, stapes). Inner: cochlea (hearing), semicircular canals (balance). CN VIII (vestibulocochlear) controls hearing and equilibrium. Nose & Sinuses: External and internal nose, septum, turbinates. Sinuses: frontal, maxillary, ethmoid, sphenoid (air-filled, lighten skull, resonance). Mouth & Throat: Lips, teeth, gums, tongue, oral mucosa, tonsils, oropharynx. CN IX and X for gag/swallow; CN XII for tongue movement. Neck: Houses thyroid gland, trachea, and lymph nodes. Thyroid: secretes T3/T4; normally not palpable.
Lymph nodes: filter lymph, indicate local infection when enlarged.
2. Health History Cues (Subjective Data)
Ask about: Eyes: vision changes, pain, discharge, redness, double vision. Ears: hearing loss, tinnitus, vertigo, pain, discharge. Nose/Sinuses: congestion, discharge, bleeding, allergies, sinus pain. Mouth/Throat: sore throat, difficulty swallowing, hoarseness, oral sores. Neck: swelling, pain, stiffness, thyroid problems. Pediatric/geriatric cues: developmental milestones, dentition, sensory decline.
3. Physical Examination Techniques (Objective Data)
Inspection: Head: symmetry, size, facial expression. Eyes: lids/lashes, conjunctiva, sclera, pupils, ocular alignment. Ears: shape, lesions, discharge, tympanic membrane (should be pearly gray). Nose: symmetry, mucosa, septum, turbinates. Mouth: lips, teeth, gums, tongue, mucosa, tonsils. Neck: symmetry, trachea, thyroid, ROM. Palpation: Lymph nodes (preauricular → supraclavicular): note size, mobility, tenderness. Thyroid (posterior approach): feel for size, nodules, tenderness. Sinuses: frontal and maxillary tenderness. Special Tests: Eyes: Snellen chart, confrontation (visual fields), corneal light reflex, cover test, EOMs, ophthalmoscope exam. Ears: Whisper, Weber, Rinne tests, otoscopy. Nose: Patency, sinus palpation.
7. Documentation Example (HEENT Exam)
Eyes: PERRLA, EOM intact, conjunctiva clear, sclera white, red reflex present. Ears: TM pearly gray, light reflex intact, hearing grossly intact. Nose: Septum midline, mucosa pink, sinuses non-tender. Mouth/Throat: Oral mucosa moist, no lesions, tonsils 1+. Neck: Supple, trachea midline, no lymphadenopathy or thyromegaly.
8. Key Clinical Takeaways
Use proper lighting and instruments (otoscope, ophthalmoscope). Document all abnormal findings precisely. Screen for oral cancer, hearing loss, glaucoma per age/risk. Correlate systemic conditions (e.g., hypothyroidism) with HEENT signs.
