HEENT Assessment

The HEENT Assessment is a comprehensive examination conducted during routine physical examinations. Learn more about it through this guide.

By Matt Olivares on May 15, 2024.

Fact Checked by Ericka Pingol.

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What is the HEENT Assessment?

The comprehensive assessment is often conducted by health care providers (often nurse practitioners with the necessary physical exam skills) during a routine physical examination. This assessment focuses on several body systems, specifically a patient's head, eyes, ears, nose, and throat, which are assessed in that order. Healthcare professionals rely on this assessment to evaluate patients and gauge any possible symptoms pointing to potential problems tied to these areas that will help diagnose conditions. All of this helps to keep your patient's wellbeing.

The examination begins with H, which stands for Head. For this part of the physical examination, healthcare professionals will assess a patient's skull, scalp, and face. They will gauge them for any abnormalities, such as asymmetry, deformities, lesions, lumps, parasites, swelling, and tenderness.

Next is the first E, which is for the Eyes. Professionals will check the patient's visual acuity for this part of the assessment. They will also examine their eyelids, iris, pupils, etc., and assess their eye movement and coordination.

After the Eyes is the second E, which is for the Ears. You're probably guessing, “Hearing tests, right?” Well, yes, but not just hearing tests. This assessment segment involves examining the external ears, ear canals, and eardrums to see if there are any inflammations, blockages because of wax, and other things that probably shouldn't be in the ear canal, and infections.

The penultimate part of the assessment is N, which is for the Nose. For this part of the assessment, professionals will examine the external nose before checking the nasal passages for infections, polyps, and other abnormalities.

The last part of the assessment is T, which is for the Throat. To end the assessment, professionals will inspect the parts of the throat, from the oral cavities to the tonsils, to check for abnormalities such as infections and inflammations. They will also check their vocal cords to gauge if they can properly swallow.

Check out this video if you want to see how to perform the first part of a HEENT Assessment:

Printable HEENT Assessment

Download this HEENT Assessment to assess a patient’s head, eyes, ears, nose, and throat.

What are the steps involved in conducting the HEENT Assessment?

If we're being honest, the HEENT examination is a lot! If you're reading this, you're likely someone who conducts this assessment occasionally, so hopefully, this part of the guide serves as a refresher on what you need to do. Sometimes we forget, but that's alright! Please note we won't go into detail about certain tests that make up this assessment since you should know about those tests.

It's also best for the practitioner to have all the tools in a clinician toolbox, like a tounge depressor, otoscope, small flashlight for the eyes, etc.

Let's start with the Head! But before anything, there's something you need to note and ensure: you have to wash your hands several times during the HEENT exam because you will be touching the patient's head during this assessment.

Head

  • Visual inspection: check the head and face for symmetry or asymmetry.
  • Visual inspection: check the hair for color, distribution, and texture.
  • Palpation: check the scalp and skull for tenderness.
  • Palpation: check the scalp and skull for flaking, lesions, and other deformities.

Eyes

  • Check the alignment of the eyes.
  • Check for the presence of discharge, irritation, and redness.
  • Check the eyelids for any drooping.
  • Check the strength of each eyelid by having your patient shut their eyes. Try to open their eyes. You shouldn't be able to if the eyelids are strong.
  • Check the sclera and conjunctiva for both eyes.
  • Check the cornea, iris, and lens for transparency.
  • Check the pupils and compare them. Test them by conducting the PERRLA Eye Exam.
  • Check the six cardinal positions of the gaze.
  • Check for conjugate gaze.
  • Check for nystagmus.
  • Check the visual fields in both eyes: medially/laterally, superiorly/inferiorly.
  • Check their visual acuity using a Snellen Chart.
  • Check their ocular fundi using an ophthalmoscope.
  • Check the transparency of the anterior and posterior chambers.
  • Check the red reflex of the retina.

Ears

  • External inspection: check the pinna for abnormalities that may point to skin cancer and gout
  • External inspection: check the external auditory canal for redness, swelling, and earwax.
  • If there is earwax, clear the ears.
  • Check the middle ear canal.
  • Perform an Otoscopy with an otoscope: check the color and shape of the eardrums (and if they're bulging or retracted), cone of light, umbo, the long and short processes of the malleus, pars tensa, pars flaccida, and the annulus.
  • Hearing acuity: conduct the Whisper Test.
  • If their acuity doesn't seem good, conduct the Weber Test and Rinne Test to check for deafness. These require a vibrating tuning fork.

Nose

  • Visual inspection: check the nose's color, shape, size, and symmetry.
  • Visual inspection: check for any presence of drainage, tenderness, and masses.
  • Nasal passage inspection: use an otoscope or nasal speculum to check for patency, nasal mucosa for color, nasal septum for deviation, and turbinates for color and swelling.
  • Check the frontal and maxillary sinuses for tenderness and infections.
  • Check the frontal and maxillary sinuses are nontender to palpitation.
  • Check their sense of smell using any of the following: an orange or lemon peel, coffee, vinegar, vanilla, or peppermint.
  • Check if the patient reports difficulty smelling.

Throat

  • Lips inspection: check for color, moisture, masses, cracks, sores, fissures, and symmetry.
  • Oral mucosa inspection: check for color, lesions, dryness, moisture, masses, and swelling.
  • Tongue inspection: check for color, thickness, moisture, symmetry of movement left and right, and deviations from the midline. Also check the tongue and the floor of the mouth for any masses and swelling.
  • Mouth: Inspect posterior pharynx
  • Teeth inspection: check for their general condition and evaluate if any teeth are missing.
  • Check for any oral cavity.
  • Gums inspection: check for color, texture, swelling, retraction, and bleeding.
  • Uvula inspection: check for movement, position, size, symmetry, and color.
  • Pharynx inspection for color, redness, inflammation, exudate, masses, and lesions.
  • Tonsils inspection: check for size, color, inflammation, and exudate.
  • Salivary glands (parotid, sublingual, and submaxillary) inspection: check for patency and signs of inflammation or redness.
  • Check the patient's gag reflex and ability to swallow.
  • Check for an enlarged thyroid gland at the suprasternal notch.

That's all of it! Or is there more?

This physical assessment actually has six components. The last one is the Neck! If you ask us, it should have been called HEENT and Neck Exam, or HEENNT Assessment to accommodate it. 

Here are the things you need to check for the Neck:

  • Check neck muscles for symmetry, masses, and swelling.
  • Palpation: check the cervical lymph nodes for any swelling or tenderness.
  • Assess the head and the neck's range of motion.
  • Assess the strength of the trapezius muscle.
  • Assess the strength of the cervical muscle.
  • Check the trachea for deviation.
  • Check the thyroid gland for enlargement.
  • Check the thyroid gland for any nodules and masses.
  • Check the posterior aspect of the neck for tenderness in the cervical point.

If there are any abnormal findings, it would be best to update the patient's health history to record any risk factors and other problems that have been detected.

HEENT Assessment example (sample)

Looking back at all those steps, we can say that the HEENT Assessment requires a healthcare professional to do much. Not only do you need to do all of those steps per segment, but you also have to document findings and pass them to the next person handling the patient. They, too, must also conduct this test to check if there are any changes. Comparing results is required because any changes will influence what the professionals need to take note of and address (if it needs addressing). To help with this, we created a HEENT Assessment template that lists everything you need to do while giving you space for each segment to note your observations! Here's what it looks like:

If you like what you see and believe this will make sharing HEENT Assessment results more efficient, download our free HEENT Assessment PDF template! We hope it helps!

Download this HEENT Assessment Example:

HEENT Assessment Example

When is it best to conduct the HEENT Assessment?

There are several appropriate times when the HEENT Assessment is best conducted. One such time is when a patient presents themselves to healthcare professionals for an appointment and talks about problems they've been experiencing in the head, including the neck. It's best to conduct the HEENT Assessment during that time so that you can check and confirm symptoms that point to the possibility of specific problems. Of course, you have to explain this assessment before you conduct it since the patient has the right to decide whether to take it.

Conducting this assessment as soon as possible is best so that healthcare professionals can determine what other tests they need to conduct from the assessment findings and what they can add to the patient's treatment plan once the problems have been confirmed and diagnosed.

Another appropriate time to conduct this would be before deciding to schedule an operation on the patient for anything related to the head. This is an important test to conduct before deciding on surgery because this assessment can check for any abnormalities the patient has that may get in the way of surgery or cause complications. If the assessment findings detect such abnormalities and other tests confirm them, they need to be addressed first before pushing through with an operation.

What are the benefits of the HEENT Assessment?

It helps professionals evaluate their patients better

The HEENT Assessment is a comprehensive examination of a patient's head, covering not just the head but also the eyes, ears, nose, throat, and neck. This assessment allows healthcare professionals to thoroughly assess a patient's overall health when it comes to the parts of their head and identify any abnormalities that need to be addressed. This allows them to determine other tests to conduct to narrow down the problems, confirm them, and make official diagnoses.

It can help professionals create a treatment plan

Speaking of getting a comprehensive look at patients, the HEENT Assessment will also help professionals create tailor-fitted treatment plans for the patient down the line when specific problems have been confirmed and diagnosed. If the assessment detects early signs of certain problems, early intervention, prevention, and management can also be possible.

It allows professionals to educate patients about their health

Since this comprehensive examination can help professionals detect certain symptoms and signs of potential problems, they can inform their patients about what they've noticed as they conduct each part of the test. They can educate the patient about what these signs could point to. Once specific problems have been confirmed and diagnosed, they can educate them about what these problems are and what they entail. This gives them the opportunity to discuss what the patient may need to do on their part, like preventative measures and lifestyle changes, as well as answer any questions that the patient may have. Patients will feel more involved and can make decisions based on their health status.

It can be conducted again for monitoring purposes

If you have a patient confined for head-related issues, you can conduct this test again to monitor them for any changes that might occur while they are being treated. The template has comment boxes for you to jot down your findings and share with other professionals, especially those whose shifts are about to start. If there are any changes, you can easily provide all the information that others need to know so they can make whatever adjustments they need to the treatment and determine if they need to do more testing.

It can also be conducted during routine checkups. If you have a patient who returns for a routine checkup, this assessment can help you determine if they're getting better and if your treatment plan is working.

How long does it take to accomplish this assessment?
How long does it take to accomplish this assessment?

Commonly asked questions

How long does it take to accomplish this assessment?

Considering the number of things you must do, it’ll take at least an hour.

What can the assessment even find?

The HEENT Assessment allows professionals to check for infections, lesions, nasal polyps, signs of oral cancer, and more abnormalities.

Is this assessment painful?

The assessment can cause discomfort since the professional will be palpating certain parts of the head and neck. The professional should inform patients about such things before even beginning the assessment so they know what they’re up for.

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