HEENT History

Lucinda Hirahoka FNP, PA-C, MPH

September , 2004

HEENT History Descriptors1. Mode of onset

a. describe events coincident with onsetb. onset gradual or sudden?c. total duration of the symptom

2. Location of the symptom3. Character of the symptom4. Radiation of the symptom5. Frequency of the symptom6. Precipitating factors7. Aggravating factors

HEENT History8. Relieving or ameliorating factors9. Associated symptoms10. Course of symptoms (getting worse, better,

etc)11. Effect of symptoms on daily life12. 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 treatmentd. past diagnosis

13. Patients concerns

HEENT History

Review of Systems General

State of health Body weight Fatigue Weakness Fever

HEENT History

Skin Areas of increased redness/heat,

rashes, growths, sun sensitivity, itching, changes in texture, pigment or color, excessive dryness or sweating

HEENT History

Head Headaches Sinus problem

Headache 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

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

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

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

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 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

Eyes Diplopia: Double vision

Eye muscle dysfunction due to tumor, trauma, pressure of exophtalmic thyroid diseases, strabismus, intracraneal aneurysm, diabetes, brain stem disease, myasthenia gravis.

Eyes 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 Lacrimation Pain Itching Photophobia Infection Discharge Erythema

HEENT History

HEENT History

Ears Hearing

Conductive hearing loss: Loss of hearing for all frequencies

Otoesclerosis: Old age Ear wax or foreign body Chronic otitis externa or serious otitis

Ears 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 ageLoss secondary to chronic noise, severe head

trauma, mumps, acoustic neuroma, use of ototoxic medications (aminoglycosides, aspirin, quinine, furosemide); or congenital.

Ear 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 Discharge

Color of discharge: bloody, yellow, white, CSF (after trauma), brownish (wax)

Associated with ear pain and upper respiratory infection

HEENT History Nose

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 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 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

Mouth/Throat Primary Gum Disease:

Gingival hyperthrophy usually seen in patients taking Dilantyn.

Periodontal disease: Bleeding or sore gums, poor dental hygiene

Mouth

Primary Lip Disease: 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

Growths and Tumors Leukoplakia: Painless persistent white

plaques; history heavy smoker, HIV + immuno-compromised patients.

Neoplasia: Persistent lumps, sores.

Mouth Infections

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 Sore throat: Frequent complaint,

usually associated with URI. Infections of the throat:

Pharyngitis Mononucleosis Herpangina Peritonsillar abscess Epiglottitis

Throat 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

PMH/Chronic Illness Medications Allergies Habits Family History Social History HCM