Lecture Notes: Head, Ears, Eyes, Nose, and Throat - Head and Neck Assessment

Initial Inspection

• Goal: Assess the head and neck of a patient.
• Steps:
  • Inspect the Head:
    • Look for deformities, lumps, lesions, and hair pattern.
    • Check skull size: Normocephalic (normal size), Macro (large), or Micro (small).
    • Example: Assistant's skull is normocephalic with no visible lumps or lesions.
  • Inspect the Face:
    • Check for symmetry along the face and jawline.
    • Observe facial expressions for anxiety, fear, aggression (teeth grinding, jaw tightness).
    • Asymmetry could indicate brain lesions from stroke or Bell's palsy.
    • Ensure nose, mouth, eyes, and brow line are midline and symmetrical.
  • Inspect the Neck:
    • Look for trachea symmetry; it should be midline.
    • Deviation might indicate pneumothorax or pleural effusion.

Palpation

• Palpate the Skull:
  • Feel for unseen deformities or hair loss.
• Palpate the Chin and Cheeks:
  • Check for bumps or masses; ensure facial symmetry.
• Assess the Ears:
  • Look for symmetry.

Lymph Node Examination

• Goal: Ensure lymph nodes are soft, non-tender, and movable.
• Lymph Nodes to Palpate:
  • Preauricular: In front of the ear.
  • Postauricular: Behind the ear.
  • Occipital: Base of the skull.
  • Parotid: Over the parotid gland.
  • Submandibular: Under the mandible.
  • Submental: Under the chin.
  • Superficial Cervical Chain: Side of the neck.
  • Deep Cervical Chain: Deeper along the neck.
  • Posterior Cervical Chain: Back of the neck.
  • Supraclavicular: Above the clavicle.
• Indicators of Issues: Firmness, swelling, or pain might suggest lymphedema, HIV, or infection.

Thyroid Examination

• Palpation:
  • The thyroid gland should not be palpable; may feel like small butterfly wings if present.
  • Done from a posterior or anterior approach while the patient swallows.
  • Any palpable mass might indicate hyperthyroidism.

Auscultation

• Purpose: Listen for bruit (turbulent blood flow) over the thyroid.
• Procedure:
  • Listen near the carotid artery to check for any whooshing sound.
  • Enlarged thyroid may cause turbulent blood flow.
  • No bruit indicates normal condition.

Summary

• The assessment includes inspection, palpation, and auscultation steps.
• Ensure symmetry, proper alignment, and no abnormal findings in head, face, and neck.
• Regular checks for lymph nodes, thyroid gland, and blood flow ensure early detection of potential health issues.