What Is the HEENT?
Have you ever wondered what the doctor is doing when he or she begins your physical exam? Why do you have to follow the doctor's finger left and right? Why do you have to stick out your tongue? What is the doctor looking for and what is considered normal?
HEENT is the abbreviation for head, ears, eyes, nose, and throat and is usually the beginning of a physical exam. The exam begins with visual assessment and is finished with palpation, if needed. Palpation is touching to determine if deficiencies exist that may be relevant to the current health of the patient. The results from this exam determine the level of care that the patient receives because this exam reveals the overall health status of the patient.
Those in the medical field are taught to begin at the patient's head or the top of the body. Different medical training allows for different exams. For example, a physician focusing on the ears, nose, and throat, or ENT specialist, will focus more on the HEENT exam than a cardiovascular surgeon who would check the head, eyes, ears, nose, and throat but would focus more on how those organs interact with the heart and cardiovascular system.
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Basic HEENT Exam
Head and Neck
The exam starts with the head. In visually examining the head, you look for deformities or asymmetry. If there is swelling, bulge, or dent on the head, gentle pressure or conversation with a patient would determine if the HEENT exam needs to move toward brain injury. If there is deformity, indention, or swelling in the skull of the patient, the patient needs medical intervention as fast as possible. The neck is reviewed at this time and should be symmetrical and without deformity.
After the physical condition of the skull has been assessed, you move on to the eyes, ears, nose, and mouth. In reviewing the eyes, you look the patient in the eye to assess eye movement, dilation, and general condition. For eye movement, you gauge if the eyes move together or apart, or not at all. In looking at eye dilation, are the eyes similarly dilated or unequal, and do the pupils respond to light?
Eye dilation is assessed with an ophthalmoscope if you are a physician or a penlight if you are a nurse or EMT. Lack of eye dilation or unequal eye dilation is a sign of a serious brain injury and requires immediate medical attention.
Ears are generally checked for cuts and abrasions and hearing acuity. Acuity is the sharpness of hearing. A physician will check the ears with an otoscope, checking the internal ear for damage and functionality. An otoscope is a medical device used to view the inner ear.
Nose and Mouth
The nose and mouth should not have fluid drainage but should be moist and symmetrical upon visual inspection. Asymmetry and fluid drainage should be noted. A physician would use the ophthalmoscope to check for blockages and throat status, and request the well known 'AHHHH' to check for throat abnormalities. An ophthalmoscope is a focused light source that is used to examine the eyes and throat.
The front of the throat would be visually examined next. You would review for jugular vein distention and trachea symmetry. The presence of either of these would indicate a serious medical condition, such as cardiac tamponade, and require immediate medical attention. Cardiac tamponade is the pressure created when fluid fills between the pericardial sac and the heart muscle.
While there are many details of the patient status that are revealed in the HEENT exam, the exam is done very quickly and easily, generally taking 2-3 minutes or less when things are normal. If an abnormality is found, then the focus is on the abnormality, as abnormalities in the head, eyes, ears, nose, and mouth are generally quite serious, reflecting likely damage to the nervous system. For these reasons, it is important that the HEENT exam be done quickly.
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HEENT: Definition & Exam
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