HEENT History

1
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

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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

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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 doesnt 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.

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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.

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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

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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.

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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 (Menieres), 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.

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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

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Mouth

• Growths and Tumors
• Leukoplakia Painless persistent white plaques
  history heavy smoker, HIV immuno-compromised
  patients.
• Neoplasia Persistent lumps, sores.

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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.

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Throat

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

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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

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HEENT History

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