Step-by-Step HEENT Assessment Guide with Normal Findings
Step-by-Step HEENT Assessment Guide with Normal Findings
A HEENT assessment —which stands for Head, Eyes, Ears, Nose, and Throat —is a fundamental part of the physical examination. Whether you’re a nursing student, medical assistant, or preparing for clinical rotations, knowing how to perform a thorough HEENT exam is essential for identifying both normal and abnormal findings.
In this guide, we’ll walk through each component of the HEENT assessment step by step, including normal findings , tools needed, and important things to observe.
🧠 What Is a HEENT Assessment?
The HEENT assessment involves examining the structures of the head and neck to assess for signs of illness, injury, or abnormalities. It is often performed as part of a general physical exam or when a patient presents with symptoms such as headache, vision changes, hearing loss, nasal congestion, or sore throat.
🔧 Tools You’ll Need
Before beginning the assessment, gather these basic tools:
- Penlight
- Tongue depressor
- Gloves
- Stethoscope (if assessing thyroid or carotid arteries)
- Snellen chart or near vision card (optional)
- Otoscope
- Ophthalmoscope
- Measuring tape (for head circumference if needed)
🧾 Step-by-Step HEENT Assessment
1. Inspection of the Head
Purpose: Assess for symmetry, deformities, trauma, or swelling.
Steps:
- Observe the size and shape of the head.
- Check for any lumps, lesions, or scars.
- Look for facial symmetry (ask the patient to smile or raise eyebrows).
- Assess for involuntary movements or tremors.
Normal Findings:
- Normocephalic (normal head shape and size)
- No visible injuries, masses, or asymmetry
- Symmetrical facial features
2. Eye Assessment (Vision and External Structures)
Purpose: Evaluate visual acuity, eye alignment, and external eye health.
Steps:
- Ask the patient to read from a Snellen chart (or use a near vision card).
- Observe eyelids for drooping (ptosis), redness, or swelling.
- Inspect sclera (whites of eyes) and conjunctiva.
- Check pupils for size, shape, and equality.
Normal Findings:
- Visual acuity 20/20 or corrected to 20/20
- No ptosis or lid lag
- Sclera white, conjunctiva pink without discharge
- Pupils equal, round, and reactive to light (PERRLA)
3. Pupillary Response and Extraocular Movements
Purpose: Assess cranial nerves III, IV, and VI function.
Steps:
- Shine a penlight into each pupil to check direct and consensual response.
- Perform the “H” test by asking the patient to follow your finger in all six cardinal directions.
Normal Findings:
- Pupils constrict briskly to light
- Smooth and coordinated extraocular movements
- No nystagmus (involuntary eye movement)
4. Ear Assessment
Purpose: Identify abnormalities in the external ear and hearing.
Steps:
- Inspect the auricles for position, symmetry, and deformities.
- Palpate the pinna and behind the ears for tenderness or swelling.
- Use an otoscope to examine the external auditory canal and tympanic membrane.
Normal Findings:
- Auricles symmetric and positioned parallel to the outer canthus of the eye
- No pain on palpation
- External canal clear with no redness or drainage
- Tympanic membrane pearly gray, intact with visible cone of light
5. Nose and Sinuses
Purpose: Assess patency, mucosa, and sinus health.
Steps:
- Inspect the external nose for symmetry or deviation.
- Examine the nasal mucosa using a penlight and nasal speculum.
- Ask the patient to blow their nose to assess patency.
- Palpate sinuses for tenderness (frontal and maxillary).
Normal Findings:
- No nasal flaring or deformity
- Nasal mucosa pink and moist
- Septum midline with no perforation
- Clear nasal discharge or none at all
- No sinus tenderness
6. Mouth and Throat
Purpose: Evaluate oral health, dentition, and signs of infection or inflammation.
Steps:
- Ask the patient to open their mouth wide and say “ah.”
- Use a tongue depressor and penlight to inspect the oral cavity.
- Examine the lips, gums, teeth, tongue, palate, uvula, and tonsils.
Normal Findings:
- Lips pink, moist, and smooth
- Teeth present or dentures fitting well
- Gums pink and firm with no bleeding
- Tongue midline, moist, with no ulcers or lesions
- Uvula rises midline when saying “ah”
- Tonsils 1+ or not enlarged, no exudate
7. Neck Assessment
Purpose: Assess for lymphadenopathy, thyroid enlargement, or carotid bruits.
Steps:
- Inspect the neck for symmetry and visible pulsations.
- Palpate cervical lymph nodes (submental, submandibular, preauricular, etc.).
- Palpate the thyroid gland.
- Auscultate the carotid arteries for bruits.
Normal Findings:
- Neck midline, supple, and non-tender
- Lymph nodes non-palpable or small (<1 cm), mobile, and non-tender
- Thyroid non-enlarged, smooth, and non-tender
- No carotid bruits
✅ Summary Checklist of Normal HEENT Findings
💡 Tips for Performing a Great HEENT Exam
- Always explain what you’re doing before touching the patient.
- Wash hands or use hand sanitizer between patients.
- Be gentle, especially when inserting instruments like an otoscope.
- Document findings clearly and compare with previous exams when possible.
- Report any abnormal findings promptly.
📝 Final Thoughts
Mastering the HEENT assessment is a valuable skill that will serve you throughout your healthcare career. Whether you’re preparing for clinicals, NCLEX, or just brushing up on fundamentals, practicing this step-by-step approach will help you build confidence and competence in evaluating patients effectively.
Remember: A good HEENT exam isn’t just about checking boxes—it’s about observing, listening, and connecting with your patient to provide safe, quality care.
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