Neck Arthritis: Understanding How Cervical Spondylosis Can Cause Throat Problems

Can arthritis in the neck cause throat problems?

Yes, arthritis in the neck, specifically cervical spondylosis, can indeed cause a variety of throat problems. This occurs due to the anatomical proximity of the cervical spine to the pharynx and esophagus, allowing for potential mechanical compression, inflammatory spread, or nerve irritation.

Understanding Neck Arthritis (Cervical Spondylosis)

Cervical spondylosis is a common degenerative condition affecting the joints and discs in the neck. It is essentially the "wear and tear" arthritis of the cervical spine. As we age, the intervertebral discs can lose hydration and elasticity, leading to disc space narrowing. Concurrently, the facet joints at the back of the vertebrae can degenerate. In response to this degeneration and instability, the body may form bone spurs, known as osteophytes, along the edges of the vertebrae and facet joints. These changes can lead to:

• Chronic neck pain and stiffness.
• Reduced range of motion.
• Nerve root compression (radiculopathy), causing pain, numbness, or weakness in the arms and hands.
• Spinal cord compression (myelopathy), leading to more widespread neurological symptoms.

While typically associated with musculoskeletal pain, the close anatomical relationship between the cervical spine and the structures of the throat means that these degenerative changes can sometimes extend their influence beyond the direct spinal column.

Anatomy of the Neck and Throat Connection

To understand how neck arthritis can affect the throat, it's crucial to appreciate the intricate anatomy of the cervical region:

• Cervical Vertebrae: The seven bones of the neck (C1-C7) form the backbone of this region.
• Pharynx (Throat): Located directly anterior to the cervical spine, the pharynx is a muscular tube that extends from the base of the skull to the esophagus. It serves as a passageway for both air and food.
• Esophagus: This muscular tube begins at the bottom of the pharynx, running downwards directly in front of the cervical and thoracic vertebrae, transporting food to the stomach.
• Trachea (Windpipe): Lies anterior to the esophagus, conducting air to the lungs.
• Major Nerves: Several critical nerves, including branches of the vagus nerve (cranial nerve X) and the sympathetic nerve chain, run in close proximity to the cervical spine. These nerves play vital roles in swallowing, voice production, and autonomic functions.
• Prevertebral Muscles: A group of muscles (e.g., longus colli, longus capitis) lie between the anterior surface of the cervical vertebrae and the posterior wall of the pharynx and esophagus.

This close anatomical arrangement means that structural changes in the cervical spine can directly or indirectly impact the adjacent throat structures.

Mechanisms of Throat Involvement

Several mechanisms explain how cervical spondylosis can lead to throat problems:

• Direct Mechanical Compression: This is the most common and well-understood mechanism. Large osteophytes (bone spurs) that form on the anterior (front) aspect of the cervical vertebrae can directly protrude into the space normally occupied by the pharynx or esophagus. This physical impingement can obstruct the passage of food or even lead to chronic irritation. Similarly, large disc herniations, though less common anteriorly, could also cause compression.
• Inflammation and Edema: The degenerative processes in arthritic joints involve inflammation. This local inflammation, along with associated edema (swelling), can extend to the adjacent soft tissues of the pharynx and esophagus. This localized inflammatory response can cause discomfort, swelling, and impaired function of the throat muscles.
• Nerve Irritation or Compression:
  • Vagus Nerve: Branches of the vagus nerve innervate the pharynx and esophagus, controlling swallowing reflexes and vocal cord function. While direct vagus nerve compression by cervical spondylosis is rare, irritation from inflammation or subtle mechanical impingement could potentially affect its function, leading to swallowing difficulties or voice changes.
  • Sympathetic Chain: This nerve chain runs along the anterior aspect of the cervical spine. Irritation or compression here could lead to autonomic symptoms that manifest as throat discomfort or altered salivary production.
  • Recurrent Laryngeal Nerve: Though less common, severe osteophytes at the lower cervical levels could potentially affect the recurrent laryngeal nerve (a branch of the vagus nerve), which controls most of the intrinsic muscles of the larynx (voice box), leading to hoarseness.
• Referred Pain: While not a primary cause of mechanical throat problems, chronic pain from the cervical spine can sometimes be referred to the throat area, causing a sensation of discomfort or soreness.
• Muscle Spasm and Dysphagia: Chronic neck pain and poor posture associated with cervical spondylosis can lead to tension and spasm in the surrounding neck muscles, including the prevertebral muscles. This muscle dysfunction can indirectly affect the coordinated muscular actions required for proper swallowing, contributing to dysphagia.

Common Throat Symptoms Associated with Neck Arthritis

Patients with cervical spondylosis may experience a range of throat-related symptoms, which can vary in severity:

• Dysphagia (Difficulty Swallowing): This is the most frequently reported throat symptom. It can range from a mild sensation of food sticking to severe difficulty swallowing solids, and sometimes even liquids. Patients may describe needing to chew food longer, taking multiple attempts to swallow, or experiencing a sensation of food getting "caught."
• Odynophagia (Painful Swallowing): Less common than dysphagia, but possible if there's significant inflammation or irritation.
• Globus Sensation: A persistent feeling of a "lump in the throat" or a foreign body sensation, even when nothing is physically there. This is often described as a constant discomfort or tightness.
• Hoarseness or Dysphonia: Changes in voice quality, including a rough, breathy, or strained voice, potentially due to irritation of nerves controlling the vocal cords or muscular tension.
• Chronic Cough or Throat Clearing: Persistent irritation in the throat area can trigger a chronic cough or the need for frequent throat clearing.
• Sore Throat Sensation: A persistent feeling of a sore or scratchy throat, often without signs of infection.

Diagnosis and Differential Diagnosis

Diagnosing throat problems caused by neck arthritis requires a thorough medical evaluation to rule out other, more common causes. The diagnostic process typically involves:

• Detailed Medical History and Physical Examination: Including a review of neck symptoms, swallowing difficulties, and other associated complaints.
• Imaging of the Cervical Spine:
  • X-rays: Can show disc space narrowing and osteophyte formation.
  • MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, including discs, spinal cord, and surrounding structures, helping to identify nerve compression or inflammation.
  • CT Scan (Computed Tomography): Excellent for visualizing bone spurs and their relationship to the pharynx and esophagus.
• Swallowing Studies:
  • Barium Swallow (Esophagram): The patient swallows a barium solution, and X-rays are taken to visualize the passage of liquid and food, identifying any obstructions or functional abnormalities.
  • FEES (Fiberoptic Endoscopic Evaluation of Swallowing): A thin, flexible scope is passed through the nose to visualize the pharynx and larynx during swallowing.
• ENT (Ear, Nose, and Throat) Consultation: An ENT specialist can examine the throat directly to rule out other causes of swallowing difficulties, such as tumors, strictures, or vocal cord paralysis.
• Neurological Evaluation: To assess for any nerve involvement.

It is crucial to differentiate throat problems caused by neck arthritis from other conditions, such as gastroesophageal reflux disease (GERD), thyroid disorders, infections, allergies, or actual throat lesions, which are often more common causes of throat symptoms.

Management Strategies

Treatment for throat problems related to neck arthritis focuses on managing the underlying spinal condition and alleviating symptoms:

• Conservative Management:
  • Physical Therapy: Exercises to improve neck posture, strength, flexibility, and range of motion. Manual therapy techniques may also be used.
  • Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation, muscle relaxants for muscle spasms, and sometimes neuropathic pain medications if nerve irritation is a significant factor.
  • Lifestyle Modifications: For dysphagia, dietary changes such as eating softer foods, cutting food into smaller pieces, chewing thoroughly, and taking smaller sips of liquids can be helpful.
  • Injections: Corticosteroid injections into specific joints or nerve blocks may be considered for pain relief.
• Swallowing Therapy: If dysphagia is significant, a speech-language pathologist can provide specific exercises and strategies to improve swallowing mechanics.
• Surgical Intervention: In rare cases, if conservative treatments fail and there is clear evidence of severe mechanical compression of the esophagus or pharynx by large osteophytes, surgical removal of the bone spurs (osteophytectomy) or other decompression procedures may be considered. This is typically reserved for severe, persistent dysphagia that significantly impacts quality of life.

When to Seek Medical Attention

While many throat symptoms can be benign, it's important to consult a healthcare professional if you experience:

• Persistent or worsening difficulty swallowing.
• Painful swallowing.
• Unexplained weight loss.
• New or worsening hoarseness.
• Choking episodes during eating or drinking.
• Any neurological symptoms such as weakness, numbness, or tingling in the limbs, or problems with balance.

In conclusion, while not the most common cause, arthritis in the neck can indeed manifest with throat problems. Understanding the intricate anatomy and potential mechanisms of involvement is key to proper diagnosis and effective management, emphasizing the interconnectedness of the human body.