Reasons for Cobblestone Throat and How to Relieve It
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Medically reviewed by Brian Bezack, DO
Cobblestone throat refers to a bumpy, cobblestone-like texture that can form in the back of the throat when the tissues are inflamed. Cobblestone throat is a symptom rather than a condition, so it usually goes away once the underlying cause resolves.
Cobblestone throat can happen for a variety of reasons, including a viral infection, postnasal drip, or from breathing in dry air. While home remedies will not cure the underlying cause, they can help relieve the soreness, hoarseness, and other symptoms that often come with cobblestone throat.
This article explains what cobblestone throat is along with the infections, illnesses, and other conditions that can cause it. It also provides a list of tips and treatments for reducing and preventing throat irritation.
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What Is Cobblestone Throat?
Cobblestone throat is caused by enlarged lymphatic tissue in the tonsils and adenoids, which are glands in the back of the nasal passage that help filter out bacteria and viruses.
These lymphatic tissues swell as part of an immune response to extra mucus in the back of the throat, leading to the formation of bumps. The bumps take on the appearance of a cobblestone road, hence the term "cobblestone throat."
Healthcare providers sometimes use the term when referring to pharyngitis or sore throat. Pharyngitis can either be an acute (short duration) symptom, or chronic (lasting 12 weeks or more).
Acute Pharyngitis
With acute pharyngitis, pain and inflammation develop quickly and can occur with or without drainage. In many cases, inflammation and sore throat are stand-alone symptoms that can last for up to two weeks. Acute pharyngitis is often caused by viral or bacterial infections.
Chronic Pharyngitis
Chronic pharyngitis is a sore throat that lasts longer than 12 weeks. The discomfort associated with a chronic sore throat can also come and go over time. Recurrent viral and bacterial infections can cause chronic sore throat. However, chronic conditions like allergies, acid reflux, and chronic mouth breathing are more often to blame. Although rare, sore throat can also be a sign of head and neck cancer.
Other Causes of Sore Throat
Some less common but sometimes more serious causes of sore throat include:
Cancer: Including Kaposi sarcoma (cancer of gastrointestinal tissuess) and leukemia
Gastroesophageal reflux disease (GERD): A more severe form of acid reflux
Peritonsillar abscess: Pus-filled tissue at the back of the mouth, near the tonsils
Diphtheria: A serious bacterial infection
Epiglottitis: A life-threatening infection in the vocal cords
Herpes simplex virus: A virus causing oral and genital herpes
Mononucleosis: A contagious infection caused by Epstein-Barr virus
Symptoms
Cobblestone throat often occurs with other symptoms, such as:
Sore throat
Dry, scratchy throat
Pain when swallowing
Pain when speaking
The symptoms you experience depend on the underlying cause.
For example, cobblestone throat that occurs without a cough or nasal congestion most likely points to a bacterial infection. On the other hand, a viral infection is more likely to cause fatigue, muscle aches, headache, and fever in addition to cobblestone throat.
Causes
Bacterial or viral infections cause most cases of pharyngitis. A stuffy nose with postnasal drip, a leaking of nasal drainage down the back of your throat, can cause a cobblestone effect.
Bacterial infections are more common in the winter and spring, while viral infections are more common in the summer and fall. Strep throat, a bacterial infection, is a common cause of acute pharyngitis.
You can also develop redness and inflammation in your throat from allergies or other irritants like smoke, hot liquids, or other trauma.
Could It Be COVID-19?
Cobblestone throat has been reported as a symptom of COVID-19. However, each variant of the illness has unique symptoms, and not all include a sore, cobblestone throat. The same variant can cause different symptoms in each infected person.
Redness and inflammation of the throat can occur with the COVID-19 illness or from coughing brought on by the illness. It's important to rule out other causes, too. Your healthcare provider may test you for COVID-19 and influenza (the flu), strep throat, or respiratory syncytial virus (RSV) when making a diagnosis.
Read Next: Causes of Throat Pain and Treatment Options
When to See a Healthcare Provider
An acute sore throat can last up to two weeks, while chronic infections last longer. If your sore throat lingers for more than a few weeks or worsens over time, you should make an appointment to see a healthcare provider.
Takeaway
Seek immediate medical attention if your sore throat develops with severe symptoms like:
Difficulty swallowing
Speech problems
A sore throat that doesn't go away or includes unusual symptoms could be a sign of more serious problems like throat cancer or GERD.
Treatment and Home Remedies
There isn't a specific treatment for cobblestone throat. Since it manifests as a symptom of another underlying condition, it will go away once that underlying condition resolves.
A viral infection usually clears on its own, although healing may take a few weeks. If a bacterial infection like strep throat causes inflammation and swelling, your provider will likely prescribe antibiotics to resolve the infection.
Whether your sore throat is caused by a viral or bacterial infection, or something else, there are several home remedies you can try to ease your discomfort:
Drink plenty of fluids.
Drink tea or warm liquids with honey.
Suck on hard candy or lozenges.
Use a humidifier to add moisture to the air.
Gargle with salt water.
Gargle with water and a dash of cayenne pepper, which contains an anti-inflammatory compound called capsaicin.
Over-the-counter (OTC) pain-relief medications like Tylenol (acetaminophen) or Advil or Motrin (ibuprofen) may be used to treat pain and swelling.
Related: Post-Nasal Drip Treatment
Prevention Tips
You can't avoid every infection, but there are a number of things you can do to reduce your risk of developing pharyngitis. This includes:
Staying current with vaccinations (such as for the flu and COVID-19)
Staying away from people who are sick
Avoiding contact with your mouth or face with unwashed hands
Summary
A sore throat can take on a cobblestone appearance, with redness and swelling. Sore throats can be caused by bacterial or viral infections or result from other illnesses or irritations. Talk to your healthcare provider if your sore throat isn't getting better after two to three weeks.
Frequently Asked Questions
How long does cobblestone throat last?
Pharyngitis, which can give your throat a cobblestone appearance, can last for two weeks, but in some cases, it may linger for longer. Your healthcare provider can help you identify a cause and find proper treatment.
What’s a healthy throat color?
Most throats are pink and smooth, but bacteria and viruses can cause redness, bumps, or irritation. Talk to your healthcare provider if you notice drainage, swelling, or lumps in the back of your throat.
Can you treat cobblestone throat with just OTC medication?
Depending on the cause of your symptoms, OTC medications and home remedies may be enough to resolve a cobblestone throat. If the cause is viral, there is no real cure and the illness will have to run its course. Bacterial infections usually require antibiotics.
Is cobblestone throat contagious?
Some forms of pharyngitis are contagious. Bacterial infections like strep and viral infections like SARS-CoV-2 that causes COVID-19 can all be passed from person to person. A sore throat caused by allergies or postnasal drip isn't as likely to be contagious.
