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Physical (Eyes, Ears, Nose & Face)

Eyes

Physical examination (Physician assessment)			Self-scoring is possible with some items, but examinations of the eyes, ears, nose, and face are best accomplished by healthcare professionals.
	Score	Normal expectations	Recommended action steps
Eyes
Left right visual acuity [Grade according to Snellen chart read-out: L (20/x), R(20/y) (score 0 if 20/20, 1 if otherwise for uncorrected or corrected vision)]		20/20	Corrective lenses to be considered
Exophthalmos (bulging eyes) [normal (score 0)/exo (score 1)]		No bulging	Exophthalmos requires medical consultations
Enophthalmos (sunken eyes) [normal (score 0)/eno (score 1)]		Not sunken	Enophthalmos requires medical consultations
Ptosis (drooping of upper eyelid) [For each of the following items, score 1 if ptosis is present, otherwise 0]		No ptosis	Surgical correction only necessary if patient incurs vision problems or has concerns about appearance
Left eye
Right eye
Bilateral
Edema of eyelid [For each of the following items, score 1 if edema is present, otherwise 0]		No edema	Edema requires medical consultations
Left
Right
Bilateral
Conjunctiva [For each of the following items, score 1 if specified condition is present, otherwise 0]		White, inner lower eyelid pink, no follicles, no discharge.	Any abnormalities require medical consultations.
Unusual coloration/discoloration (signs of anemia, jaundice, inflammation)			Unusual colorations require medical consultations.
Discharge			Discharge requires medical consultations.
Pupils [For each of the following items, score 0 if the description or test is affirmative, otherwise score 1]
Round pupils		Round
Equal in size		Equal in size
Reactive to light test		Bilateral reaction
Distance accommodation test		Dilate according to distance focus
Involuntary eye movement (nystagmus) [yes (score 1)/no (score 0)]		No involuntary eyes movement
Eye misalignment (strabismus) [yes (score 1)/no (score 0)]		Perfect symmetry
When was the last time you had a check-up by an eye doctor? [Score 1 if more than a year, otherwise 0]		Annual
Overall score

 

Reminder: Accumulated score of zero requires no further action. The user is encouraged to discuss with a healthcare provider any line items scored as 1 and proceed with remedial actions as appropriate. Save or print the table. All forms will reset to blank state once the user exits the website.

 

"Prevention is better than cure" Desiderius Erasmus

Access Live Excel Spreadsheet Here

Ears

Physical examination (Physician assessment)			Self-scoring is possible with some items, but examinations of the eyes, ears, nose, and face are best accomplished by healthcare professionals.
	Score	Normal expectations	Recommended action steps
Ears
External ear appearance (score 1 if evident, otherwise 0)
Otitis externa		Absent	Requires immediate treatment if present
Mastoiditis		Absent	Requires immediate treatment if present
Basic hearing test & Otoscopy (score 0 for pass, 1 for fail)
Left & Right whisper test		Satisfactory test
Tuning fork Weber's Test		Satisfactory test
Tuning fork Rinne's Test		Satisfactory test
Ear canal obstruction (score 1 if yes, otherwise 0)		None	Requires immediate treatment if present
Tympanic membrane perforation (score 1 if yes, otherwise 0)		None	Requires consultations with an ENT doctor
Acute otitis media (score 1 if yes, otherwise 0)		None	Requires immediate treatment if present
Complete audiometry test [Corrected or uncorrected hearing loss (score 1 if yes, otherwise 0)]		Recommended and satisfactory normal hearing expected.	Hearing loss requires consultations with an ENT doctor
Overall score

 

Reminder: Accumulated score of zero requires no further action. The user is encouraged to discuss with a healthcare provider any line items scored as 1 and proceed with remedial actions as appropriate. Save or print the table. All forms will reset to blank state once the user exits the website.

 

"Prevention is better than cure" Desiderius Erasmus

Access Live Excel Spreadsheet Here

Face & Nose

Physical examination (Physician assessment)			Self-scoring is possible with some items, but examinations of the eyes, ears, nose, and face are best accomplished by healthcare professionals.
	Score	Normal expectations	Recommended action steps
Face
Trigeminal nerve test [For the next 3 items score 0 if response to test is satisfactory, otherwise score 1]
Bilateral V1, V2, V3 sensory response test		Pass test
Jaw muscle response/reflex test		Pass test
Corneal reflex test		Pass test
Nose & paranasal examination
External inspection & palpation [For the next 4 items, score 1 if the condition is present, otherwise 0]
Septal deviation		Straight allowing equal air patency
Airway obstruction		None	Requires immediate treatment if present
Tenderness/pain over sinus bony structures		None	Requires immediate treatment if present
Nose base furunculosis		None	Requires immediate treatment if present
Nasal vestibule, anterior lateral walls and septum inspection [For the next 4 items, score 1 if the condition is present, otherwise 0]
Traumatic septum dislocation		None	Requires consultations with an ENT doctor
Nosebleed/crusting/ulceration		None	Requires immediate treatment if present
Nasal discharges/rhinitis/sinusitis		None	Requires immediate treatment if present
Polyps		None	Requires consultations with an ENT doctor
Overall score

 

Reminder: Accumulated score of zero requires no further action. The user is encouraged to discuss with a healthcare provider any line items scored as 1 and proceed with remedial actions as appropriate. Save or print the table. All forms will reset to blank state once the user exits the website.

 

"Prevention is better than cure" Desiderius Erasmus

Access Live Excel Spreadsheet Here