(4) Check nasal discharge. If there is nasal discharge, assess its color,
consistency, and odor. Also, check for blood in the discharge. The patient may have
an allergy or a cold if the discharge is profuse and thin.
(5) Examine the sinuses. Palpate the sinuses. Apply pressure gently to the
nostrils, orbital rims, and cheeks. If the patient experiences pain after pressure is
applied above the upper orbital rims, the patient has frontal sinus irritation. If he feels
pain after pressure is applied to the cheeks, he has maxillary sinus irritation.
EXAMINATION OF MOUTH/PHARYNX
a. Mouth. Ask the patient to open his mouth wide. Depress his tongue with the
tongue blade in the middle of the tongue. The posterior tongue is involved in the gag
reflex. Check the following structures:
(1) The tongue. Inspect the top, bottom, and sides. Test for movement,
taste, and sensation. The normal variants of the tongue include a deeply furrowed
The teeth. Check for caries (cavities). Also, check for broken teeth.
(3) Gums. Inspect for redness which could indicate inflammation (infection).
Also, check for bleeding. Bleeding could be an indication of poor brushing habits or
(4) Mucous membranes. Check for pallor or redness. Either could be a
sign of an unhealthy mouth.
b. Pharynx. Shine a bright light in the mouth and on the throat. Inspect for
inflammation or white patches. If necessary, take a throat culture to identify infection-
SPECIFIC ITEMS TO LOOK FOR IN AN HEENT INSPECTION
Look for these conditions when you are conducting a head, eyes, ears, nose, and
a. The Bony Skull: Trauma.
(1) Mandibular joint dislocation --obvious with malpositioned mandible
(jawbone) and decreased range of motion.
Skull fracture--watery discharge, bloody discharge from cranial orifices.
(3) Battle's sign--discoloration behind the ear, an indication of a fracture of
the base of the skull.