From the Guidelines
The key physical findings to look for on a HEENT exam include assessing the eyes for excessive lacrimation, erythema, and swelling of the bulbar and/or palpebral conjunctiva, as well as evaluating the nose for reduced patency, nasal turbinate hypertrophy, and discharge, and examining the ears for tympanic membrane dullness, erythema, and retraction, as outlined in the practice parameter for the diagnosis and management of rhinitis 1. When performing a HEENT exam, it is essential to evaluate each component systematically.
- For the eyes, look for signs such as excessive lacrimation, erythema, and swelling of the bulbar and/or palpebral conjunctiva, cobblestoning of the tarsal conjunctiva, and "allergic shiners" 1.
- The nose should be assessed for reduced patency, alar collapse, transverse external crease, septal deviation, nasal turbinate hypertrophy, edema, pallor, or erythema, and crusting, as well as the presence of discharge or nasal polyps 1.
- Ear examination should include inspecting the tympanic membrane for dullness, erythema, retraction, perforation, or reduced mobility, and assessing for air-fluid levels 1.
- The oropharynx should be evaluated for halitosis, dental malocclusion, high arched palate, tonsillar or adenoidal hypertrophy, and the presence of pharyngeal postnasal discharge 1. These physical findings can help identify common conditions such as rhinitis, as well as more serious pathologies that may require further investigation or specialist referral. It is also important to note that the presence of certain physical findings, such as "allergic shiners," may not be specific to allergic rhinitis, as they can be found in nonatopic individuals as well 1. Therefore, a comprehensive HEENT exam, combined with a thorough medical history and additional testing, such as skin testing for specific IgE, can help provide an accurate diagnosis and guide treatment 1.
From the Research
HEENT Exam Findings
The key physical findings to look for on a HEENT (Head, Eyes, Ears, Nose, Throat) exam include:
- Edematous and pale turbinates in patients with seasonal allergic rhinitis 2
- Erythematous and inflamed turbinates with serous secretions in patients with perennial allergic rhinitis 2
- Nasal congestion, rhinorrhea, and postnasal drainage in patients with allergic rhinitis 2, 3, 4
- Itching of the eyes, nose, and throat in patients with allergic rhinitis 2
Nasal Findings
Nasal findings on a HEENT exam may include:
- Increased nasal secretion, as measured by the Intranasal Schirmer Test (INS) 5
- Elevated total nasal symptom scores (TNSS) in patients with allergic rhinitis 5
- Reduced nasal symptoms and improved nasal quality of life score with treatment, such as fluticasone propionate aqueous nasal spray 6
Eye and Throat Findings
Eye and throat findings on a HEENT exam may include: