Many critical structures like the sensory organs, cranial nerves and major blood vessels originate in the head and neck. which is why their study and inspection must be very careful to detect symptoms and pathologies within these anatomical regions.
However for each of the individual "HEENT" components there is a special technique for inspection.
HEENT
Head
Eyes
Ears
Nose
Throat
THE HEAD
Through inspection you can see, shape, symmetry and if there is any collapse.
To recognize shapes you must have to palpate the head from front to back with gentle movements of rotation , identifying likewise if there headache, because is a most symptoms in clinical practice, with lifetime prevalence of 30% in the general population. Among types of headaches most common is migraine.
Hair inspection in quantity , thickness , dry , oily or if there are alopecia , paying attention to the areas behind the ears . Regarding the hairy skin to whether there skin lesions , crusting, inflammation , maculas , paracite , etc.
THE EYES
For the analysis of the eyes is important to start with basic questions such as: What is your vision? Do you have any discomfort in your eyes?, according to the answers, it will be easier to make a diagnosis or simply to continue the inspection.
First we analyze the orbits of the eyes, ensuring that there is no swelling, eyelid position, if any difficult to open or close them, how they flash.
To feel the eyes is important to push into the orbitaria cavity without the patient present discomfort, in order not to feel nodules, conjunctiva examined for reversing the upper eyelid where color with clear, analyzed or sclerotic visible.
Regarding the cornea must analyze whether there is corneal transparency, projecting tangentially flashlight over his eyes and analyze if there is miosis, mydriasis or anisocoria, if there is an alteration in this test will need to cover and Experience and enjoy her eye repeatedly to diagnose; the color of the iris and pupil shape.
For the analysis of the cornea it is done by touching a swab and there must be a blink reflex and bilateral.
Finally there is the study of visual acuity.
THE EARS
We must first analyze the shape, size and symmetry, if there is any variation in the ears and if they are firm, mobile and show no pain, lesions, or nodules appearance of nevi.
The inspection of the external auditory canal must see beyond the absence of secretions and pain, canal walls in a pink coloration, tympanic membrane with good condition to perform this test requires the patient tilt your head to the opposite shoulder this serving as support for the test in this way can enter the speculum is gently.
A key data for the analysis is heard during interrogation, if the patient responds correctly and smoothly hear the questions tells us that his hearing is in good condition.
If hearing problems appear you can use the Rinne test is to vibrate and place the base of the tuning fork in the mastoid process and record the seconds until hear the sound stops.
THE NOUSE
Analyze shape, size, color, if it fits the size of the face width of the nostrils, if symmetrically oval, when there is an alteration may be a depressed nasal bridge, asymmetry, fluttering and narrowing.
An important part of the nose to be inspected is the nasal septum, which is not painful on palpation, good permeability of the nostrils, easy breathing, usually when there is a problematic breathing is noisy, no tenderness and displacement bone.
To inspect the nasal mucosa should lay the patient's head back and have a mucosa pink and bright coloration, nasal turbinates of the same color, straight shape, good layer of secretion and presence of villi.
As for the detection of a very common pathology that is related to the frontal and maxillary sinuses it is necessary that these be palpated by gentle pressure with the thumbs hoping that there is no pain, as well as can strike the maxillary sinuses and frontal . The above is functional to detect sinusitis.
THE ORAL
The oral examination should be performed with good lighting and using un drop - language.
Aspects:
The following must be observed:
- Inspection:
1. Color and symmetrical mobility of the lips, changes in the characteristics of the skin and mucous (ulcerations, induration and tenderness)
2. With open lips must examine the arrangement of the teeth and dental occlusion. The teeth missing and the status of the remaining (presence of caries). Jaw mobility grade and symmetry in the mouth opening should also be noted, as well.
3. shape and mobility of the tongue (hypoglossal paresis rule) should be evaluated. Evaluate the relationship between size of the tongue and oral cavity size. To examine the floor of the mouth, the patient to raise the tongue, so you can watch the Wharton duct wattles are asked.
4. You need to pay close attention to the characteristics of the mucosa of the mouth and cheeks evaluating the color, texture, dryness, presence of membranes, ulcers, tumors and changes in sensitivity.
5. Examine the hard and soft palate, looking for alterations in its closure as cracks or impaired mobility, as happens with the glossopharyngeal nerve paresis in which the uvula deviates toward the healthy side. Evaluate the characteristics of the uvula.
6. In low-tongue should be examined the upper and lower lobbies of the oral cavity.
7. parotid duct should be inspected or Stenon seeking his mouth at the second upper molar. If simultaneous palpation of the parotid gland is performed on the same side it can be seen the output of saliva and its characteristics.
8. Finally the low-Language characteristics of tonsils, pillars and pharyngeal mucosa should be observed. It is important to note the size, color, presence of ulcers, purulent discharge or membranes.
- Palpation: Any suspicious area in the oral cavity should always be palpated, like the base of the tongue as it is an area that is not displayed in the physical examination.