Cobblestone Throat: Symptoms, Pictures & Treatment (2023)

What is Cobblestone Throat (Pharyngitis)?

Cobblestone throat, also known as pharyngitis, is inflammation of the back of the throat (pharynx). It typically results in a sore, scratchy throat and may cause difficulty swallowing.

What many people refer to as a sore throat is usually pharyngitis. There are two types:

Acute Pharyngitis

Most cases of pharyngitis are acute, lasting only a few days to a week. But it can last longer.

Acute pharyngitis is a common symptom of upper respiratory tract infections. Some people experience two or three cases of sore throat in a typical year.

Chronic Pharyngitis

You may have chronic pharyngitis if you have a sore throat that lasts several weeks. The cause might be from an irritant, such as:

  • Stomach acid reflux
  • Smoking cigarettes or vaping
  • Exposure to other types of smoke
  • Excess mucus

What are the Symptoms of Cobblestone Throat?

The main symptom of pharyngitis is a sore throat, which may be all you notice. But you can also experience additional symptoms, such as:

  • A lumpy, cobblestone appearance on the back of the throat
  • Swelling of the throat and/or tonsils
  • Redness
  • Difficulty swallowing
  • Hoarse voice or difficulty talking
  • Throat pain

Depending on the underlying cause, these throat symptoms may also be accompanied by:

  • Dry cough
  • Fever
  • Runny nose
  • Swollen lymph nodes
  • Headache
  • Muscle aches
  • Nausea
  • Fatigue
  • Bad breath

What Does Cobblestone Throat Look Like?

Cobblestone throat gets its name from the pebble-like bumps that form in the tissue at the back of the throat. Many people get alarmed by these raised bumps—thinking they may be cancerous growths or signs of HPV—but they’re harmless.

The “cobblestones” are simply fluid-filled tissue. These bumps develop as part of your body’s natural response to infection or irritation. They’ll go away after the cause of your pharyngitis has been treated.

What Causes Cobblestone Throat?

Many things can cause a sore throat. Pharyngitis is often a symptom of a viral infection. Bacteria or other conditions can also cause cobblestone throat.

Viral Infections

Most cases of pharyngitis are caused by viral infections. These include:

  • Adenovirus
  • Influenza
  • The common cold (rhinovirus)
  • COVID-19
  • Mononucleosis (Epstein-Barr virus)
  • Chickenpox
  • Croup
  • Herpes simplex virus
  • Hand, foot, and mouth disease (enterovirus)
  • HIV

Bacterial and Fungal Infections

The most common bacterial cause of cobblestone throat is group A streptococcus. This condition is better known as strep throat (streptococcal pharyngitis).

Though less common, other bacterial infections can cause pharyngitis. These include the bacteria that cause gonorrhea and chlamydia infections.

Fungal infections, such as oral thrush, can also cause cobblestone throat..

Other (Non-Infectious) Causes

Sometimes pharyngitis isn’t caused by an infection. Your throat may be irritated by any of the following:

  • Dry or cold air
  • Seasonal allergies
  • Smoking or vaping
  • Acid reflux
  • Vocal cord strain
  • Hormonal changes associated with pregnancy
  • Eating spicy foods
  • Having an object stuck in your nose

These irritants can also cause post-nasal drip, where excess mucus builds up in the nose and sinuses and drips down the back of the throat. Post-nasal drip can contribute to throat irritation.

You may be experiencing chronic pharyngitis due to seasonal allergies or a smoking habit. These can cause your throat to remain sore for multiple weeks.

When to See a Doctor

If symptoms persist for longer than a few days, it might be time to see a doctor. You should also see a doctor if you experience severe symptoms, such as:

  • High fever
  • Shortness of breath
  • Difficulty swallowing
  • Drooling
  • Chest pain
  • Ear pain
  • A lump on your neck
  • Throat swelling
  • Speech problems
  • Vomiting or coughing up blood
  • Unexplained weight loss

An ongoing sore throat accompanied by abnormal symptoms can signify a serious health condition, such as throat cancer.

Potential Complications

Streptococcal pharyngitis can lead to complications if left untreated, such as:

  • Rheumatic fever (inflammation of multiple organs, including the heart)
  • Kidney disease (glomerulonephritis)
  • Peritonsillar abscess

These complications don’t always occur in untreated strep throat, but they can be prevented by taking proper antibiotics.

Diagnosing Cobblestone Throat

A healthcare provider will examine your throat and neck to understand your condition better. They’ll also ask you about your symptoms and medical history.

This information may not be enough to determine the exact cause of pharyngitis. A throat swab is often used to rule out strep throat. This can include a rapid strep test and/or a throat culture.

Treatment for Cobblestone Throat

If you have pharyngitis due to a viral infection, your sore throat and other symptoms will probably subside within a week. In the meantime, you may be prescribed or recommended medication to help with the pain.

You can also use the following to thin the excess mucus irritating your throat:

  1. Over-the-counter (OTC) steroid nasal sprays
  2. Non-drowsy antihistamines
  3. Decongestants

For a bacterial infection such as strep throat, your healthcare provider will likely prescribe antibiotics to prevent complications and speed up recovery. You must take the entire course of antibiotics as prescribed.

For cases of non-infectious pharyngitis, treatment varies. Your healthcare provider may recommend reducing exposure to certain irritants, such as smoke.

Can You Prevent Cobblestone Throat?

You can reduce your likelihood of getting viral or bacterial pharyngitis by:

  • Washing your hands regularly
  • Avoiding sharing food and drinks with others who may be sick
  • Avoiding close contact with people who show symptoms
  • Regularly disinfect used surfaces such as phones, doorknobs, and handles
  • Maintain a nutritious diet and a healthy lifestyle that includes adequate sleep
  • Stress management like yoga, meditation, deep breathing, and other mindfulness techniques

You can also make non-infectious pharyngitis less likely by being mindful of possible throat irritants and other allergens that are triggering your body’s immune system. Consider quitting smoking and limiting your consumption of alcohol and acidic foods.

Home Remedies for Cobblestone Throat

You can help your body recover from pharyngitis by resting and drinking plenty of water. To avoid infecting others, stay home until you’re no longer sick.

During this time, you can also try some home remedies to help soothe your throat and make recovery easier.

Comforting Food and Drinks

Warm beverages help soothe sore throats and, in some cases, provide nutrients. Here are some suggestions:

  • Avoid caffeine and alcohol — these substances dehydrate the body, which can worsen a sore throat.
  • Try a comforting herbal tea — some herbal teas are specifically formulated to help relieve throat pain.
  • Add honey to warm water or herbal tea — honey has antimicrobial properties and can help reduce a cough. Manuka honey, in particular, may be the most effective.
  • Drink warm brothbone broth calms a sore throat and is also high in protein and other essential nutrients.
  • Gargle with warm salt water — a traditional remedy for relieving throat discomfort.

You may also want to try something cold to soothe your throat, such as ice cream or a popsicle. To avoid irritating your throat, try to stick to soft, non-crunchy foods while you’re sick.

Lozenges and Sprays

Throat lozenges containing menthol, pectin, zinc, and other ingredients can temporarily relieve a sore throat. They also help prevent coughing.

In addition, sprays are available to numb or soothe your throat. You might want to try a throat spray containing propolis, a natural bee product with antibacterial properties.

Sleep Upright

Sleeping upright and with a pillow supporting your lower back can prevent mucus from accumulating at the back of your throat, preventing further irritation.

Humid Air

If dry air contributes to your irritated throat, breathing in steam from a hot bath or a boiling pot of water may give you some relief.

Lastly, humidifiers add moisture to the air in your home. Be sure to clean your humidifier regularly to prevent mold accumulation.


  • Cobblestone throat, also known as pharyngitis, is inflammation of the back of the throat
  • Cobblestone throat is a common symptom of certain viral, bacterial, and fungal infections
  • Most cases of pharyngitis are acute, lasting a few days to a week
  • In some cases, pharyngitis is chronic, persisting for multiple weeks
  • Chronic pharyngitis is likely attributed to repeated exposure to an irritant, such as smoke
  • Depending on the cause, pharyngitis may be accompanied by a fever, cough, and other symptoms

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