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

Area
Normal Finding
Head
Normocephalic, no deformities
Eyes
PERRLA, 20/20 vision, white sclera
Pupils
Equal, round, reactive to light
EOMs
Full and smooth movement
Ears
Intact TM, clear canal, no discharge
Nose
Midline septum, pink mucosa
Mouth
Pink lips, healthy gums, midline uvula
Throat
No exudate, 1+ tonsils
Neck
Supple, no lymphadenopathy, no bruits

? 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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