HEENT

A focused HEENT assessment begins with the patient’s change from baseline, not with a memorized parade of body parts. Ask when the problem began, whether it is worsening or intermittent, how severe it is, and whether it is one-sided or bilateral. Laterality often narrows the pattern: unilateral hearing loss, nasal discharge, eye findings, or neck swelling deserves a different level of attention than a mild, symmetric complaint. Clarify associated fever, pain, discharge, hearing or vision change, tinnitus, vertigo, headache, facial pressure, altered smell or taste, dysphagia, odynophagia, voice change, and dyspnea. Ask about tobacco and alcohol exposure, recent upper-respiratory infection, allergies, dental symptoms, trauma, foreign-body exposure, contact lenses, and medications. Anticoagulants and intranasal or ophthalmic products can change the significance of bleeding, redness, or irritation. Ask about relevant systemic symptoms such as weight loss, night sweats, weakness, rash, or focal neurologic change. The first clinical question is whether the symptom threatens airway, breathing, vision, hearing, or neurologic function. A patient who says, “My throat hurts,” may have uncomplicated pharyngitis, but drooling and a muffled voice change the assessment into an...