1. Lucinda Hirahoka FNP, PA-C, MPH September , 2004
HEENT History
Lucinda Hirahoka FNP, PA-C, MPH
September , 2004

2. HEENT History Descriptors Mode of onset
a. describe events coincident with onset
b. onset gradual or sudden?
c. total duration of the symptom
Location of the symptom
Character of the symptom
Radiation of the symptom
Frequency of the symptom
Precipitating factors
Aggravating factors

3. HEENT History 8. Relieving or ameliorating factors
9. Associated symptoms
10. Course of symptoms (getting worse, better, etc)
11. Effect of symptoms on daily life
12. 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 treatment
d. past diagnosis
13. Patients concerns

4. HEENT History Review of Systems General State of health Body weight
Fatigue
Weakness
Fever

5. HEENT History
Skin
Areas of increased redness/heat, rashes, growths, sun sensitivity, itching, changes in texture, pigment or color, excessive dryness or sweating

6. HEENT History
Head
Headaches
Sinus problem

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. 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.

15. Eyes
Lacrimation
Pain
Itching
Photophobia
Infection
Discharge
Erythema

16. HEENT History

17. 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

18. 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 age
Loss secondary to chronic noise, severe head trauma, mumps, acoustic neuroma, use of ototoxic medications (aminoglycosides, aspirin, quinine, furosemide); or congenital.

19. 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.

20. Ears
Discharge
Color of discharge: bloody, yellow, white, CSF (after trauma), brownish (wax)
Associated with ear pain and upper respiratory infection

21. 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.

22. 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.

23. 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.

24. HEENT History Mouth/Throat Primary Gum Disease:
Gingival hyperthrophy usually seen in patients taking Dilantyn.
Periodontal disease: Bleeding or sore gums, poor dental hygiene

25. 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

26. Mouth Growths and Tumors
Leukoplakia: Painless persistent white plaques; history heavy smoker, HIV + immuno-compromised patients.
Neoplasia: Persistent lumps, sores.

27. 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.

28. Throat Sore throat: Frequent complaint, usually associated with URI.
Infections of the throat:
Pharyngitis
Mononucleosis
Herpangina
Peritonsillar abscess
Epiglottitis

29. 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

30. HEENT History PMH/Chronic Illness Medications Allergies Habits
Family History
Social History
HCM