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HEENT History
Lucinda Hirahoka FNP, PA-C, MPH
September , 2004
HEENT History
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Descriptors
Mode of onset
a. describe events coincident with onset
b. onset gradual or sudden?
c. total duration of the symptom
Location of the symptom
Character of the symptom
Radiation of the symptom
Frequency of the symptom
Precipitating factors
Aggravating factors
HEENT History
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Relieving or ameliorating factors
Associated symptoms
Course of symptoms (getting worse, better, etc)
Effect of symptoms on daily life
Past treatment or evaluation of the symptom
a. when, where, by whom?
b. what studies were done and what were the
results?
c. results of past treatment
d. past diagnosis
13. Patients concerns
HEENT History
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Review of Systems
General
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State of health
Body weight
Fatigue
Weakness
Fever
HEENT History
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Skin
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Areas of increased redness/heat, rashes,
growths, sun sensitivity, itching, changes in
texture, pigment or color, excessive
dryness or sweating
HEENT History
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Head
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Headaches
Sinus problem
Headache
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Muscle Tension Headache: Constant band like
pressure lasting days to weeks; usually worse
at the end of the day; often occipital location
Migraine Headache: Throbbing, often
unilateral frontal headache; usually visual
prodromata, nausea and vomiting precede
the attack. Positive family history of migraine
Headache
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Sinus Headache: Facial pain often
associated with nasal stuffiness and
discharge; increased when head is flex
forward
Nonspecific Febrile Headache: Muscle
aches and pains
Headache
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Cervical Arthritis: Occipital and neck
ache worse with neck movement;
patient usually over 40 years old
Trigeminal Neuralgia: Brief jabs of facial
pain caused by touching a trigger point.
Frequently seen after shingles of the
trigeminal nerve
Headache
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Serious Cases of Headaches
Meningitis: Recent development of
fever, headache, nausea, and vomiting
Subarachnoid bleeding: Very rapid
onset of unilateral headache often with
change in consciousness or neurologic
function; vomiting is common
Headache
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Temporal arteritis: Temporal headache
with body aches, often in patients over
40 years old; transient decrease in
vision may progress to blindness
Hypertensive Crisis: Blurring vision; a
history of HTN is common
History
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Intracranial Mass: No characteristic history;
most suspect is recent headache that doesn’t
fit the above patterns
Subdural Hematoma: Headache and level of
consciousness may wax and wane over
months, usually in the very old or alcoholics
with history of head injury
HEENT History
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Eyes
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Diplopia: Double vision
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Eye muscle dysfunction due to tumor, trauma,
pressure of exophtalmic thyroid diseases,
strabismus, intracraneal aneurysm, diabetes,
brain stem disease, myasthenia gravis.
Eyes
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Changes in acuity: Decrease or loss of
vision. Important to know whether it
happened suddenly or gradually. Sudden
visual loss suggest retinal detachment,
vitreous hemorrhage, or occlusion of the
central artery
Blurring: Is commonly caused by refractive
errors; high blood sugar also causes
blurred vision.
Eyes
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Lacrimation
Pain
Itching
Photophobia
Infection
Discharge
Erythema
HEENT History
HEENT History
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Ears
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Hearing
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Conductive hearing loss: Loss of hearing for all
frequencies
Otoesclerosis: Old age
Ear wax or foreign body
Chronic otitis externa or serious otitis
Ears
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Nerve deficit-Type Hearing Loss
High frequency hearing loss is often noted. The
patient may note difficulty when listening on the
telephone or in groups.
Prebyscus: Old age
Loss secondary to chronic noise, severe head
trauma, mumps, acoustic neuroma, use of
ototoxic medications (aminoglycosides, aspirin,
quinine, furosemide); or congenital.
Ear
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Ear Pain: Unilateral or bilateral. History of
upper respiratory infection with nasal
congestion. Ear pulling or tagging
increases pain, inability to “pop” ears.
Tinnitus: Ringing or buzzing in ears. It
increases with age. Sometimes associated
with hearing loss and vertigo (Meniere’s),
or high dose ASA use.
Ears
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Discharge
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Color of discharge: bloody, yellow, white, CSF
(after trauma), brownish (wax)
Associated with ear pain and upper respiratory
infection
HEENT History
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Nose
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Discharge: Common complaint is rinorrhea or
nasal discharge, which is often associated with
nasal stuffiness. Important to find out color of
discharge: clear, whitish, yellow, greenish, bloody.
Acute runny, stuffy nose is due to viral URI; a
chronic runny stuffy nose is usually related to
excessive decongestant use, vasomotor rhinitis, or
allergic rhinitis.
Nose
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Epistaxis: Bleeding from the nose. The
Kiesselback plexus is the most common
site associated with anterior septum
bleeding. The most common cause of nose
bleeding in children is trauma “nose
picking”.
Other causes are inflammation, drying and
crusting of the mucosa, tumors, foreign
bodies, and bleeding disorders.
Nose
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Sense of smell changes: Alterations may be
noted following infection, trauma, allergic
rhinitis; rarely noted in neurologic disease.
Obstruction: Due to congestion, foreign
object or polyps which are often associated
with history of asthma.
HEENT History
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Mouth/Throat
Primary Gum Disease:
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Gingival hyperthrophy usually seen in
patients taking Dilantyn.
Periodontal disease: Bleeding or sore
gums, poor dental hygiene
Mouth
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Primary Lip Disease:
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Herpes simplex: Painful lesions on lips or in
mouth
Cheilosis: Cracking and inflammation of the
corners of the mouth; often the patients
are edentulous
Mouth
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Growths and Tumors
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Leukoplakia: Painless persistent white
plaques; history heavy smoker, HIV +
immuno-compromised patients.
Neoplasia: Persistent lumps, sores.
Mouth
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Infections
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Candida: Common in diabetics, infants, HIV+,
antibiotic and adrenal steroids use.
Canker sore: Painful recurrent ulcers in the mouth
and lips
Vitamin deficiency: Gingival bleeding, cheilosis,
oral ulcers, hyperthrophic tongue. Usually seen in
the alcoholic and or malnourish patient.
Dental caries: gum soreness, abcess.
Throat
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Sore throat: Frequent complaint, usually
associated with URI.
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Infections of the throat:
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Pharyngitis
Mononucleosis
Herpangina
Peritonsillar abscess
Epiglottitis
Throat
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Hoarseness: Refers to an altered quality of
the voice, allergy, smoking or inhaled
irritants. Hoarseness lasting more than two
weeks needs to be refer for visualization of
the larynx.
Dysphagia: Difficulty swallowing, feeling of
obstruction, “lump in my throat”
Odynophagia: Pain with swallowing
HEENT History
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PMH/Chronic Illness
Medications
Allergies
Habits
Family History
Social History
HCM