Head and neck examination

Last updated: March 23, 2022

Summarytoggle arrow icon

Examination of the head and neck is a fundamental part of the standard physical examination. It is typically one of the first parts of the physical examination and is performed with the patient in a seated position. Because the complete head and neck examination is lengthy, it is usually tailored to the patient's history and presenting complaint. In adult patients, the parts of the examination dealing with the ears and nose are generally not required unless there is a pertinent complaint.

Examination of the headtoggle arrow icon

  • Inspect the skull and face.
  • Inspect the skin and scalp.
  • Palpate skull (especially if patient complains of tenderness or recent trauma).
  • Assess facial sensation and motor function.


Examination of the earstoggle arrow icon

  • Inspect the external ear and note any skin abnormalities or discharge.
  • For patients complaining of ear pain or discharge, gently move the auricle up and down, and apply pressure to the tragus and the mastoid process.


  • Procedure
    • Place the largest speculum that comfortably fits in the patient's ear on the head of the otoscope and turn on the light source.
    • Angle the otoscope handle either directly downward or towards the patient's forehead.
    • Stabilize your otoscope hand by placing the fourth and fifth digits on the patient's head.
    • With your free hand, pull the ear up and in a posterior direction to straighten the canal as you insert the otoscope at a slightly downward angle.
  • Interpretation
  • A pneumatic bulb allows for assessment of tympanic membrane mobility.

Otoscopy is an integral part of all pediatric examinations. It is usually only performed in adults if they have mentioned ear discomfort.

Auditory acuity

Screening assessments

  • Whispered voice test: While standing behind the patient, whisper a phrase or numbers in each ear → Ask the patient to repeat what you whispered.
  • Finger rub test: Place your fingers several centimeters from either ear → Rub your fingertips together and ask the patient if they heard it.
  • Interpretation: : If any asymmetry is detected, or the patient complains of impaired hearing, further evaluation is indicated → See hearing loss.

Tuning fork tests

  • Performed in order to distinguish between conductive hearing loss and sensorineural hearing loss. See also hearing loss.
  • Weber test: tests for lateralization (sound is heard louder in one ear than the other)
    • Place the base of a vibrating tuning fork on the middle of the forehead and ask the patient from which ear the sound is louder.
    • The sound is normally heard equally in both ears.
    • Interpretation
  • Rinne test: tests for air conduction vs bone conduction in the examined ear

Overview of possible findings

Rinne left Rinne right Weber Possible finding
Positive Positive Normal Normal hearing or bilateral sensorineural hearing loss
Positive Positive Lateralization to the left Sensorineural hearing loss in the right ear
Positive Positive Lateralization to the right Sensorineural hearing loss in the left ear
Negative Positive Lateralization to the left Conductive hearing loss in the left ear
Positive Negative Lateralization to the right Conductive hearing loss in the right ear
Negative Positive Lateralization to the right Combination hearing loss in the left ear
Deafness in the left ear
Negative Negative Normal Bilateral, symmetrical conductive hearing loss

Gelle test

  • Description: to evaluate the mobility of the ossicles, e.g., in the diagnosis of otosclerosis
  • Procedure: The vibrating tuning fork is placed against the forehead and the auditory canal is sealed using a pneumatic speculum, which creates positive pressure in the external auditory canal.
    • Gelle positive: Positive pressure disturbs both bone and air conduction. The sound of the tuning fork is perceived by the patient to be considerably weaker with the pneumatic speculum applied than without the pneumatic speculum. → Hearing is normal in the middle ear or there might be a problem in the middle ear that restricts the mobility of the ossicles.
    • Gelle negative: Despite positive pressure, there is no change in hearing in the patient. → evidence of otosclerosis

Additional tests

When screening for hearing loss, examine each ear individually in a quiet room.


Focused examination of the eyestoggle arrow icon

Inspection and palpation

  • Inspect for symmetry of the eyes and eyelids.
  • Note any swelling or redness around the eyelids, and assess whether the eyelids can fully close.
  • Inspection of the sclera (normal sclerae are white) and inspection of the conjunctivae
    • Ask the patient to look up while you hold lower lids with your thumb.
    • Inspect for color, vascular pattern, and whether there is any swelling.


Visual acuity

Visual field testing

Examination of extraocular muscles

Fundoscopic examination and other special tests


Examination of the necktoggle arrow icon

Inspection and palpation

Examination of the thyroid

  • Inspection
  • Palpation
    • Stand behind the patient.
    • Place your finger pads below the thyroid cartilage and assesses the size and consistency of the thyroid.
    • Ask the patient to swallow.
      • The thyroid should slide beneath the fingers.
      • The normal thyroid is usually not palpable.
    • Note any asymmetry or enlargement.


Examination of the nose and throattoggle arrow icon


  • Examine the external nose and test the patient's ability to breathe through either nostril by covering one at a time.
  • Examine the nasal mucosa, septum, and turbinates using an otoscope.
    • Use the largest available speculum that will comfortably fit inside the nostril.
    • Direct the speculum posteriorly and superiorly as you inspect the nasal cavity.
  • Palpate for tenderness over the maxillary and frontal sinuses.
  • Inspect the lips.
  • Inspect the oral mucosa.
  • Inspect the gums for redness or ulceration



Signs and differential diagnosistoggle arrow icon

Red flag symptoms of the head and neck


Referencestoggle arrow icon

  1. Bickley L. Bates' Guide to Physical Examination and History-Taking. Lippincott Williams & Wilkins ; 2012
  2. A Practical Guide to Clinical Medicine. Updated: September 1, 2004. Accessed: January 10, 2018.

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