Assessment of Head, Neck, Eyes, Ears, Nose, and Throat

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Assessment of Head, Neck, Eyes, Ears, Nose, and Throat

I. ASSESSMENT AND HISTORY OF THE HEAD AND NECK
FACULTY: This is for the review and discussion of history and assessment of the head and neck. This is also
the format the students should follow later in the class when they are assessing the head and neck on their
partner. These assessments are for more comprehensive assessments of the head and neck and should be
used based on findings from the review of systems.
For your health history/review of systems, remember to use the following prompts:
• Have you ever experienced…
• Do you have a history of…
• Do you have a family history of…

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I. Head
a. History (from Review of Systems): Assessment of Head, Neck, Eyes, Ears, Nose, and Throat
i. Unusually frequent or severe headaches, head injury, dizziness, vertigo
b. Inspection:
i. General size and contour
c. Palpation:
i. Deformities, lumps, or tenderness
II. Face
a. Inspection:
i. Facial expression
ii. Color and texture (especially at mouth* and earlobes)
iii. Symmetry of structures
iv. Involuntary movements
v. Edema
b. Palpation:
i. Masses or lesions
ii. Temporomandibular joint (crepitation, popping, tenderness)
III. Neck
a. History (from Review of Systems):
i. Pain, limitation of motion, lumps or swelling, enlarged or tender nodes, goiter
b. Inspection:
i. Symmetry
ii. Range of motion
iii. Abnormal pulsations
c. Palpation:
i. Strength of cervical muscles
ii. Lymph nodes and tenderness
iii. Position of trachea
iv. Thyroid gland
d. Auscultation:
i. Thyroid gland (if abnormal findings) Assessment of Head, Neck, Eyes, Ears, Nose, and Throat

II. ASSESSMENT AND HISTORY OF THE EYES, EARS, NOSE, MOUTH, AND THROAT
FACULTY: This is for the review and discussion of history and assessment of eyes, ears, nose, mouth, and
throat. This is also the format the students should follow later in the class when they are assessing the eyes,
ears, nose, mouth, and throat on their partner. Note, however, the portions that are part of the General Head
to Toe Assessment. The remainder of the assessments are for more comprehensive assessments and should
be used based on findings from the review of systems. The “other tests” may be discussed if time is available.
For your health history/review of systems, remember to use the following prompts:
• Have you ever experienced…
• Do you have a history of…
• Do you have a family history of…
I. Eyes
a. History (from Review of Systems):
i. Decreased acuity, blurring, blind spots, eye pain, diplopia, redness or swelling, watering
or discharge, glaucoma, cataracts
ii. Wears glasses or contacts, last eye exam or glaucoma test, how coping with loss of
vision if any
b. Inspection:
i. Eyebrows, eyelids, and eyelashes for abnormalities
ii. Sclera and conjunctiva for color, swelling, or lesions
iii. Pupils (equal, round, reactive to light and accommodation)*
iv. Eye movement (extraocular muscles)*
c. Other tests:
i. Snellen eye chart
ii. Confrontation test (peripheral vision)
II. Ears
a. History (from Review of Systems): Assessment of Head, Neck, Eyes, Ears, Nose, and Throat
i. Earaches, infections, discharge and characteristics, tinnitus, vertigo
ii. Hearing loss, hearing aid use, how hearing loss affects daily life
b. Inspection:
i. Size and shape
ii. External auditory meatus for size, swelling, redness, or discharge
c. Palpation:
i. Pinna and tragus for tenderness
d. Other tests:
i. Whispered voice test
III. Nose and Sinuses
a. History (from Review of Systems):
i. Discharge (characteristics), unusually frequent or severe colds, sinus pain, nasal
obstruction, nosebleeds, allergies or hay fever, change in sense of smell
b. Inspection:
i. Symmetry and deformity
c. Palpation:
i. Nasal patency
ii. Frontal and maxillary sinuses for tenderness
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IV. Mouth and Throat
a. History (from Review of Systems): Assessment of Head, Neck, Eyes, Ears, Nose, and Throat
i. Mouth pain, frequent sore throat, bleeding gums, toothache, lesion in mouth or on
tongue, dysphagia, hoarseness or voice change, tonsillectomy, altered taste
ii. Pattern of daily dental care, use of dentures, bridges, last dental checkup
b. Inspection:
i. Lips for color, moisture, cracking, or lesions
ii. Teeth and gums for abnormalities
iii. Tongue for color, surface characteristics, look under tongue for lesions, and assess
moisture
iv. Using a wooden tongue blade and a good light source, inspect the inside of the patients
mouth including the buccal folds and under the tongue. Note any ulcers, white patches
(leucoplakia), or other lesions. If abnormalities are discovered, use a gloved finger to
palpate the anterior structures and floor of the mouth.
v. Inspect the posterior oropharynx by depressing the tongue and asking the patient to say
“Ah.” Note any tonsilar enlargement, redness, or discharge.
vi. Buccal mucosa for color, moisture, nodules, and lesions*
vii. Tonsils for size, color, and surface characteristics
c. Palpation:
i. Instruct the students to don gloves, take a gauze pad and ask the partner to stick out
their tongue. As the student holds the tongue with the gauze pad they palpate (by
sliding their finger) along the sides of the tongue for any signs of cancer-lesions. They
should also do a finger sweep of the oral mucosa assessing for any papules
V. Cranial Nerves
i. II – Optic: Confrontation Test
ii. III, IV, VI – Oculomotor, Trochlear, Abducens: PERRLA, extraocular movements in six
cardinal positions*
iii. V – Trigeminal: Light touch on forehead, cheek, and chin
iv. VII – Facial: Symmetry when smiling, frowning, closing eyes tightly, lifting eyebrows, and
puffing cheeks
v. VIII – Acoustic: Whisper test
vi. IX, X – Glossophyarngeal, Vagus: Inspect movement of uvula for rise during phonation
vii. XI – Spinal accessory: head rotation and shoulder shrug against resistance
viii. XII – Hypoglossal: Stick out tongue (midline) Assessment of Head, Neck, Eyes, Ears, Nose, and Throat

III. INTERACTIVE HEENOT CASE STUDY
FACULTY: This exercise will use only 6 students. However, the entire class will be taking notes and writing a
SOAP note during this exercise. Each week select a different group of 6 students to ensure all students have
an opportunity to participate. You will play the role of the patient for the history taking portion. Select a
volunteer or the manikin to play the role of the patient for the physical assessment section.
1. The first group of 2 students will obtain the history. (5-10 minutes)
2. The first group will then return to the group and everyone will record the history and discuss if any
additional questions should have been asked. (5 minutes)
3. The second group of 2 students will perform the physical examination on the volunteer or manikin. (10
minutes)
4. Once the second group is finished, they will return to the group and everyone will write up the objective
data and develop a plan for the patient based on the history and physical. The instructor should provide
the group with the diagnosis. Students may use their book or mobile applications /resources to develop
a plan of care. (10 minutes)
5. Once the class has developed the plan, the third group of 2 students will discuss the plan with the
patient (you will return to play the role of the patient). (5-10 minutes)
6. At the end of the simulation, have a student write their SOAP note on the white board and critique with
the class. (10 minutes) Assessment of Head, Neck, Eyes, Ears, Nose, and Throat