HEENT Questions to Ask Patient
Twenty questions for the head, eyes, ears, nose and throat review, working from the top down: headache and dizziness, vision and eye symptoms, hearing, tinnitus and ear pain, nasal blockage and bleeding, smell and taste, throat, voice, mouth and jaw, neck lumps, recent injury or procedures, and current drops, sprays and tablets. Written for clinicians and students, with notes on which answers need acting on the same day.
The questions
Open any question for the note
Are you having any headaches at the moment? Where are they, and what do they feel like?
Why ask it
Opening with the patient's own description keeps you from inheriting a label like sinus headache, which is usually wrong. Note the site and whether it is the same each time, since pain fixed to one side or one spot is followed up differently from a band across the forehead.
Have you had any dizziness, or a feeling that the room is moving?
Why ask it
The distinction between lightheadedness and true spinning changes the whole differential, and patients use the word dizzy for both. Ask what they were doing when it started and how long it lasted: seconds on rolling over in bed suggests something very different from hours with vomiting.
Has anything changed about your vision: blurring, double vision, or a patch you cannot see through?
Why ask it
A missing area of field, rather than general blurring, is the answer that matters most, and patients often only notice it when one eye is covered. Sudden loss of vision, new double vision, or a curtain coming across the field needs assessing the same day.
Any pain, redness, discharge or sensitivity to light in either eye?
Why ask it
Redness with photophobia and reduced vision is a different problem from redness with sticky discharge and normal vision. Ask about contact lens wear at the same time, because a lens wearer with a painful red eye should be examined rather than treated over the phone.
Do you wear glasses or contact lenses, and when was your last eye test?
Why ask it
Establishes whether a vision complaint might simply be an old prescription, which is common and easily missed in a busy review. It also identifies patients with no recent test at all, worth flagging if they have diabetes or a family history of glaucoma.
Has your hearing changed, in one ear or both?
Why ask it
Laterality is the key detail. Gradual loss in both ears over years is usually age-related, while loss over hours or days in one ear is treated as an emergency, and many patients wait a week before mentioning it because it does not hurt.
Any ringing, buzzing or other noise in your ears?
Why ask it
Tinnitus in both ears alongside symmetrical hearing loss is common and generally reassuring. Tinnitus in one ear only, or a noise that pulses in time with the heartbeat, is the version that warrants further investigation.
Any ear pain, discharge, or a blocked feeling?
Why ask it
Discharge and a blocked sensation are worth separating, because one suggests active infection or a perforation and the other often turns out to be wax or fluid behind the drum. Persistent one-sided fluid in an adult should prompt a look at the nasopharynx.
Do you use hearing aids, and are you wearing them now?
Why ask it
Answers this question and improves the rest of the consultation at the same time. Aids left in a drawer are extremely common, and the reason given, whistling, a poor fit, batteries, is usually fixable rather than a reason to accept the loss.
Is your nose blocked or running, and is it worse on one side?
Why ask it
Blockage that alternates sides is usually rhinitis. Blockage fixed to one side, particularly with bleeding or a reduced sense of smell on that side, is the pattern that needs examining rather than a nasal spray.
Have you had any nosebleeds, and how long do they take to stop?
Why ask it
Frequency and stopping time matter more than volume, which patients always overestimate. Ask about anticoagulants, aspirin and nasal steroid use in the same breath, and note repeated bleeds from the same side as a finding rather than a nuisance.
Any pain or pressure over your cheeks, forehead or upper teeth?
Why ask it
Facial pressure with a blocked nose and discharge supports sinus involvement, while facial pain with a completely clear nose usually has another explanation, often dental or neuralgic. Upper toothache with cheek pain is worth a dental opinion.
Has your sense of smell or taste changed?
Why ask it
Patients rarely raise this unless asked, and most reported taste loss is actually smell loss. Gradual one-sided reduction in smell alongside nasal blockage suggests something obstructing, and complete sudden loss has its own set of causes worth documenting with a date.
Any sore throat, or pain when you swallow? Does food ever feel like it is sticking?
Why ask it
The sticking question is doing separate work: it screens for a swallowing problem rather than a sore throat, and food catching at a consistent level, or weight loss with it, needs urgent assessment regardless of how the throat looks.
Has your voice changed or gone hoarse, and for how long?
Why ask it
Duration is the whole answer here. Hoarseness lasting more than about three weeks, especially in a smoker or heavy drinker, is a referral for laryngoscopy rather than something to review again in a month.
Any mouth ulcers, bleeding gums or loose teeth? When did you last see a dentist?
Why ask it
Ulcers that come and go in different places are usually benign, while a single ulcer or white or red patch in the same spot for more than three weeks should be looked at properly. Bleeding gums also picks up patients whose dental care has lapsed entirely.
Any jaw pain, clicking, or trouble opening your mouth wide?
Why ask it
Clicking with pain on chewing usually points at the joint or at grinding, and asking about morning stiffness helps distinguish them. Pain in the jaw that comes on partway through a meal in an older patient is a different question and needs same-day assessment.
Have you noticed any lumps or swelling in your neck?
Why ask it
Ask how long it has been there and whether it changes. Tender nodes that came up with a cold and are settling are expected, while a painless lump that has persisted beyond three weeks in an adult needs referral even if everything else is normal.
Have you had a head or facial injury, or any dental or ENT procedure, in the last few weeks?
Why ask it
Patients do not connect a fall or an extraction with the symptom that brought them in. Recent trauma raises the question of a fracture or a delayed bleed, and recent dental or sinus work explains a surprising amount of facial pain and altered sensation.
What are you taking at the moment, including drops, sprays, inhalers and anything you bought yourself?
Why ask it
The ones patients leave out are exactly the ones that matter here: decongestant sprays used for months, steroid inhalers causing hoarseness or oral thrush, antihistamines drying the mouth, and drops from a previous prescription used on a new problem.
Working through a HEENT review
Practical guidance for the conversation itself
How to run it
Follow the complaint first, then screen
Start where the patient is troubled and take that symptom apart properly. Only then run the rest of the region as a screen. Working top to bottom regardless of the presenting problem produces a full record and a shallow history.
Record side and duration for everything positive
In this region, laterality and time course carry most of the diagnostic weight. One ear, one nostril, one side of the field, three weeks rather than three days: those details are what decide between reassurance and referral.
Do not adopt the patient's label
Sinus, migraine, vertigo and glue ear all arrive pre-diagnosed by patients, relatives or previous notes. Ask what they actually feel and where, then classify it yourself.
Make yourself easy to hear
Face the patient, keep your mouth visible, and check whether hearing aids are in before you begin. A history that appears vague is often a history the patient could not hear the questions in.
Answers that need acting on quickly
- Sudden loss of hearing in one ear over hours or days, with no wax and no infection.
- Sudden loss of vision, new double vision, or a shadow moving across the field of one eye.
- A painful red eye with reduced vision, or any red eye in a contact lens wearer.
- Jaw pain that comes on while chewing, with scalp tenderness or visual symptoms, in a patient over fifty.
- Stridor, drooling, or difficulty swallowing saliva.
- Fixed one-sided nasal blockage with bleeding, or a persistent one-sided middle ear effusion in an adult.
- A painless neck lump present for more than three weeks, or hoarseness lasting more than three weeks.
- Facial swelling or trismus with fever after dental work.
Common pitfalls
Recording a normal review that was never asked
A negative screen means the questions were put and answered. Writing HEENT unremarkable after asking two of them is the entry most likely to mislead the next clinician.
Treating dizziness as one symptom
Without knowing whether the room spun, how long it lasted and what provoked it, the word dizzy in the notes is close to useless and will simply be asked again.
Missing what the patient left out
Smell, taste, voice change and swallowing are rarely volunteered. If those four are never asked, the review reliably misses the presentations that most need early referral.
Skipping the examination the answers point to
A positive answer about one ear, one nostril or one side of the neck sets up a specific thing to look at. Questions on their own cannot distinguish wax from fluid, or a node from a cyst.
Documenting and following up
- Note duration in weeks for hoarseness, ulcers and neck lumps, since those thresholds drive referral decisions.
- Write down every spray, drop and over-the-counter remedy with how long it has been used, particularly decongestants.
- If you are reassuring rather than referring, say what would change that: a lump that grows, a voice still hoarse in three weeks, an ulcer that has not healed.
- Give the patient one thing to watch for in their own words, and record what you told them.