Laryngeal arthritis refers to inflammation involving the cricoarytenoid joint or the cricothyroid joint.
Etiology
Cricoarytenoid arthritis and cricothyroid arthritis can result from laryngeal cartilage inflammation or laryngeal trauma. Systemic diseases that cause inflammation in other joints, such as rheumatism, rheumatoid arthritis, or gout, can also lead to laryngeal arthritis.
Clinical Manifestations
Throat pain or foreign body sensation worsens during swallowing and speaking and may radiate to the ear.
Cricoarytenoid joints control the movement of the vocal cords, while cricothyroid joints regulate vocal cord tension. Therefore, inflammation in the laryngeal joints can result in varying degrees of hoarseness.
Examination
For suspected laryngeal arthritis, laryngoscopy and palpation of the neck are typically performed, sometimes supplemented by laboratory tests if needed.
Cricoarytenoid Arthritis
Laryngoscopy may show swelling and congestion of the mucosa in the arytenoid region on the affected side. Palpation of the arytenoid region using laryngeal forceps during indirect laryngoscopy may reveal significant tenderness in the affected area. Movement of the vocal cord on the affected side may be restricted, and in severe cases, vocal cord fixation may occur due to joint immobility.
Cricothyroid Arthritis
Laryngoscopy may reveal flaccidity of the vocal cord muscles on the affected side. If the condition is unilateral, asymmetry of the glottis may be observed. Bilateral involvement of the cricothyroid joints may result in impaired joint mobility, causing flaccidity in both vocal cords and the appearance of a spindle-shaped gap when the glottis closes. Tenderness in the cricothyroid joint area on the affected side can be identified during neck palpation. Additionally, rheumatism may present with increased erythrocyte sedimentation rate (ESR), and rheumatoid arthritis typically shows positive rheumatoid factor.
Diagnosis
The diagnosis can be established based on clinical symptoms such as throat pain, foreign body sensation in the throat, and hoarseness, in combination with laryngoscopic findings. Laboratory tests, including ESR and rheumatoid factor, can provide additional confirmation if necessary. Electromyography and CT imaging may assist in differential diagnosis.
Treatment
For cases of laryngeal arthritis caused by rheumatic or rheumatoid diseases, glucocorticoids may be administered. Antibiotics are used to treat cases with bacterial infections. Throat pain may be managed with salicylates or other antipyretic and analgesic medications.
In cases of cricoarytenoid joint fixation, arytenoid cartilage mobilization can be performed in laryngoscopy. For cricothyroid arthritis, therapeutic manipulation of the cricothyroid joint may be employed.