Cobblestone Throat

What is cobblestone throat?

Cobblestone throat involves having inflamed tissue in the back of your throat that looks bumpy. Many people panic when they notice the raised tissue, thinking that the bumps may be cancerous growths. But the bumps are harmless. The “cobblestones” you see in the mirror are fluid-filled tissue that temporarily forms in response to an infection, allergen (something you’re allergic to) or other irritants.

Fortunately, a healthy immune system is good at getting rid of germs or irritants that typically cause cobblestone throat. The bumps go away once the cause resolves.

What are the symptoms of cobblestone throat?

You can tell the primary symptom of cobblestone throat by its name — bumps in the back of your throat that resemble cobblestones or pebbles. The bumps may look red, irritated or inflamed. You’ll likely have a sore throat (pharyngitis), too.

Other symptoms depend on what’s causing your cobblestone throat. They may include:

• Dry cough.
• Hoarseness.
• Bad breath.
• Stuffiness.
• Fever.
• Pain when you talk.
• Pain when you swallow.
• A tickly or scratchy throat.
• A feeling like there’s something stuck in your throat.

What causes cobblestone throat?

The bumps appear when your tonsils and adenoids become irritated and swollen. Your tonsils are a pair of soft tissues located in the back of your throat. Your adenoids are a patch of soft tissue located high in your nasal cavity behind your nose. Your tonsils and adenoids prevent germs from entering your respiratory passages. Mucus coats these tissues and your passageways to further trap germs.

Sometimes, invaders like viruses bypass these defenses and trigger your body’s immune response. When this happens, the tissue in your throat swells and mucus production increases. The increased mucus helps with flushing out germs. The mucus thickens and trickles down your throat (postnasal drip), irritating your tonsils and adenoids. The bumps in your throat are a sign of this irritation.

You can get cobblestone throat in response to:

• A cold.
• The flu.
• Allergies.
• Acid reflux.
• Breathing dry air.
• Smoking or vaping.
• Other upper respiratory infections.

COVID-19 is caused by a virus, which means cobblestone throat may result from an infection. Still, cobblestone throat isn’t a common COVID-19 symptom. Common respiratory infections, like the flu or a cold, are more likely causes.

Can HPV cause cobblestone throat?

Many people with cobblestone throat worry that the bumps are cancerous lumps or signs of an HPV infection that may become throat cancer. But cobblestone throat isn’t related to high-risk strains of HPV or throat cancer.

With cobblestone throat, HPV and oral cancer, you may have a sore throat. But neither an oral HPV infection nor throat cancer produces the characteristic bumps associated with cobblestone throat. You’re more likely to notice a lump in your neck or a red or white patch in your throat if you have a high-risk strain of HPV. Often, HPV doesn’t produce any symptoms.

Is cobblestone throat contagious?

Cobblestone throat isn’t contagious, but it may result from a contagious condition. For example, you can pass along a viral infection causing your throat irritation, like the flu, or a bacterial infection, like strep throat. Both viruses and bacteria are contagious and can lead to cobblestone throat. Other causes, like allergies or acid reflux, aren’t contagious. It depends.

The person who contracted the infection may or may not develop cobblestone throat, even if they got the germ from someone who does have it. It depends on each person’s immune response and how irritated their throat gets.

How is cobblestone throat diagnosed?

Your healthcare provider will likely be able to make a diagnosis just by examining your throat. They’ll also ask about any additional symptoms other than the bumps. They may do a throat culture to test for germs that may be causing cobblestone throat, like a virus (most common) or bacteria.

How is cobblestone throat treated?

You can get rid of cobblestone throat by eliminating what’s causing inflammation and postnasal drip. Often, your immune system can cure viral and bacterial infections on its own. If not, your healthcare provider can recommend or prescribe medications that can help.

You can treat cobblestone throat by:

• Taking antibioticsto help clear some bacterial infections.
• Avoiding allergens that are triggering your body’s immune system.
• Using over-the-counter (OTC) steroid nasal sprays, nondrowsy antihistamines and decongestants to thin the excess mucus irritating your throat.

What home remedies can help with cobblestone throat?

Any of the following home remedies can help with cobblestone throat:

• Drink lots of warm fluids: Drinking warm liquids, like soup or tea, can thin the mucus and soothe your throat.
• Gargle warm salt water: The warm water and the salt together can thin your mucus and filter out some of the allergens (pollen, dust, mold, etc.) irritating your throat. Create a saltwater mix by dissolving 1 teaspoon of salt into 1 cup of warm water.
• Try sucking on lozenges: Lozenges release medicine that can lubricate your throat, cool it and fight bacteria that may be causing your inflammation.
• Use a humidifier: A humidifier adds moisture to the air. When you inhale, the moisture softens the tissues in your sinuses and helps thin your mucus.
• Sleep upright: Sleeping upright with a pillow supporting your low back can prevent mucus from pooling at the back of your throat and further irritating it.
• Coat your throat with honey: Honey can soothe a sore throat. Studies have shown that some types of honey, like Manuka honey, can relieve inflammation and even help fight bacteria.

How can I reduce my risk?

Consider the following tips to prevent cobblestone throat:

• Identify and avoid substances that cause your allergies to flare.
• Don’t smoke, vape or expose yourself to secondhand smoke.
• Maintain a healthy lifestyle that includes a nutritious diet, exercise, adequate sleep (seven to eight hours a night) and little stress.
• Take steps to avoid bacterial and viral infections, like avoiding physical contact with sick people, masking or social distancing as needed, and washing your hands frequently.

What can I expect if I have cobblestone throat?

The bumps should disappear within a week or two if a cold or the flu caused the irritation. Cobblestone throat that doesn’t go away may be related to acid reflux, allergies or a nastier germ that your body is having trouble fighting. If the bumps persist, see your healthcare provider.

When should I see my healthcare provider?

Schedule an appointment with your healthcare provider if:

• Your symptoms worsen after several days of home treatment.
• Your symptoms haven’t improved within a week of managing them at home.
• You have severe throat pain, especially if it’s making it harder to breathe.

See a healthcare provider immediately if you’re caring for an infant you suspect has cobblestone throat.

How do I get rid of cobblestone throat?

Cobblestone throat often goes away on its own within a week or so. If it doesn’t, see your healthcare provider. They can help you identify what’s causing your cobblestone throat and recommend treatments.

Can postnasal drip cause cobblestone throat?

Yes. Postnasal drip is like having a runny nose, only in the back of your throat. The excess mucus trickles down and irritates your tonsils and adenoids, causing the tissue to enlarge and become bumpy.

Is vaping causing my cobblestone throat?

It could be. Vaping can expose your body to chemicals that irritate your sinuses and dry out your airways. This irritation can lead to a sore throat, postnasal drip and eventually, cobblestone throat.

What causes cobblestone throat that doesn’t hurt?

A sore throat often — but not always — accompanies cobblestone throat. The usual causes may be to blame even if your throat doesn’t hurt (colds, the flu, allergies, etc.). It’s also possible that the raised tissue in your throat is a sign of another condition. If your bumps don’t disappear within a week or two, see your healthcare provider to get an accurate diagnosis.

A note from Cleveland Clinic

It can be alarming to notice the bumps associated with cobblestone throat when you look in the mirror, but don’t worry. Think of the bumps as a sign that your immune system is doing what it’s supposed to do — fighting invaders like germs and allergens. The bumps often disappear within a few weeks along with other common signs like a sore throat. In the meantime, home remedies like gargling saltwater, honey, humidifiers and cough drops can help manage symptoms.