What Causes a Cobblestone Throat?

Medically reviewed by Jane Kim, MDMedically reviewed by Jane Kim, MD

Cobblestone throat is when circular bumps grow in the back of your throat. Several health conditions can cause these bumps to develop, such as viral and bacterial infections, allergies, and acid reflux. Generally, cobblestone throat is an acute (short-term) symptom that goes away as you recover from your illness.

What Does Cobblestone Throat Look and Feel Like?

Cobblestone throat forms bumps on the walls of the back of your throat. These bumps are round and tend to form in clusters, grouping together like rocks or pebbles. Typically, the growths are red and inflamed, which can irritate the throat. However, symptoms can sometimes vary depending on the exact cause of your condition, whether that's pharyngitis (sore throat), infection, or allergies.

Alongside inflamed bumps on the throat, you may experience the following symptoms:

• Burning or scratching pain

• Difficulty talking or swallowing

• Headaches

• Dry cough

• Nasal congestion

• Fever

• Skin rash

• Swollen lymph nodes

• Heartburn

• Hoarse voice

Generally, cobblestone throat is temporary and resolves as the underlying condition heals. Though the bumps may resemble cancer or precancerous growths, they’re benign (harmless).

Causes

Cobblestone throat occurs when there's swelling and inflammation in the tonsils and adenoids. These glands sit at the back of the throat and protect the respiratory passages from viruses and bacteria. Excess mucus in the back of the throat (known as post-nasal drip) causes these glands to swell, leading to the pebble-like appearance of the back of the throat.

A wide range of health conditions and factors cause this immune reaction.

Viral Infections

Viral infections are the most common causes of both pharyngitis and cobblestone throat. These infections include:

• The common cold: Along with a sore throat, the most common symptoms of the cold are headache, cough, sneezing, and post-nasal drip.

• Influenza (the flu): This is a more severe viral infection that commonly leads to a cobblestone throat. Other symptoms include a severe cough, headache, chills, fever, body aches, and fatigue.

• Herpes simplex virus: Herpes infections cause sores near the genitals or inside or around the mouth. When herpes affects the mouth, it can cause swollen glands in the neck, leading to sore throat and cobblestone throat.

• Epstein-Barr virus (EBV): A member of the herpes family of viruses, Epstein-Barr virus (EBV) causes mononucleosis (“mono”) in adolescents and children. Along with throat-related symptoms, this infection causes fatigue, fever, swollen glands, enlarged liver, and rash.

• Enteroviruses: Another widespread virus, certain enteroviruses can cause respiratory infections (like pneumonia), which lead to cobblestone throat.

Bacterial Infections

Certain bacteria that infect the upper airways can also cause post-nasal drip and cobblestone throat. Bacterial pharyngitis is most commonly caused by the streptococcus (“strep”) bacterial infection. This type of bacteria often causes strep throat and scarlet fever, both of which can cause inflamed bumps and soreness in your throat.

With strep throat, you may experience fever, white streaks on the tonsils, redness or swelling in the tonsils, and small, red spots in the mouth. Scarlet fever symptoms are similar and can include the development of red rashes on the skin.

Allergies

Allergies occur when the nasal passages become inflamed due to excess immune reactions to pollen or other airborne allergens. This leads to post-nasal drip, which causes a cobblestone throat. Allergies may be causing your cobblestone throat if they occur alongside symptoms such as:

• Itchy mouth, eyes, throat, or skin

• Loss of smell
  

• Runny nose

• Sneezing

• Watery eyes

• Dark circles under the eyes

• Coughing

• Ear inflammation

• Headache

• Fatigue or insomnia

Acid Reflux and GERD

Another potential cause of cobblestone throat is persistent heartburn, known as gastroesophageal reflux or acid reflux. This condition occurs when stomach acids flow back up the esophagus, causing heartburn, regurgitation (belching), chest pain, nausea, and problems swallowing.

However, if your acid reflux becomes severe or chronic (long-term), it can cause gastroesophageal reflux disease (GERD), which irritates the throat and leads to additional symptoms, like cobblestone throat. Alongside the bumps, this condition can cause voice hoarseness, nausea and vomiting, chronic cough, and blood in your vomit.

Smoking or Vaping

You might experience cobblestone throat and pharyngitis as a result of smoking or vaping tobacco. These habits can inflame and damage throat tissues and cause bumps to appear. Smoking and vaping can also often increase the risk of developing respiratory infections, which may cause additional symptoms like shortness of breath, chronic cough, dryness, and difficulty swallowing.

Certain Irritants

Sometimes, a cobblestone throat occurs due to environmental factors. Very dry or cold air, pollution, or smoke in your environment can also inflame and irritate the throat. As a result, you may experience pharyngitis, bumps in the throat, and post-nasal drip. These symptoms can also occur alongside coughing and watery eyes.

Less Common Causes

Several other health conditions and infections can also cause cobblestone throat. These include:

• COVID-19: There have been reports that certain forms of COVID-19 can cause cobblestone throat. COVID-19 symptoms may also include fever, loss of taste or smell, headache, cough, sneezing, and a runny nose.

• Epiglottitis: This rare, severe infection of the flap of tissue at the base of the tongue prevents food and water from going down the air pipe. Along with a cobblestone throat, this condition causes breathing or swallowing difficulties, sore throat, voice hoarseness, and fever.

• Diphtheria: A rare and severe bacterial upper respiratory infection, diphtheria causes a coating to cover tissues in the throat and mouth. This may cause cobblestone throat, flu-like symptoms, hoarseness, nausea, fever and chills, and an elevated heart rate.

When to Contact a Healthcare Provider

Depending on the underlying cause, pharyngitis—and, by extension, cobblestone throat—can either be acute or chronic. Acute cases tend to resolve within two weeks, but chronic cases can last longer, which may require you to seek medical attention from a healthcare provider. You should contact a provider if your symptoms don't go away within a couple of weeks or if you're experiencing any of the following symptoms:

• High fever (above 103 degrees Fahrenheit or 39 degrees Celsius)

• Difficulty swallowing

• Swelling in the throat

• Trouble speaking

• Coughing up blood

• Excessive vomiting

To determine what's causing your symptoms, your provider will ask about your medical history, perform a physical exam, and order a throat culture. A throat culture is a procedure that collects a swab of fluid from the throat and tests it for certain conditions.

Cobblestone Throat Treatment

If you have a cobblestone throat, your healthcare provider can recommend several treatment options, ranging from home remedies to antibiotic medications. The exact treatment you'll need will depend on the cause of your symptoms and the severity of your condition.

Home Remedies

Medications aren’t always needed for most respiratory viral infections—getting rest and drinking fluids can often help you feel better. As your body fights off the infection, however, some home remedies can help improve a cobblestone throat and soreness. These include:

• Sucking on cough drops, popsicles, or ice

• Using a humidifier

• Gargling salt water

• Drinking hot teas

• Adding honey to hot beverages

Over-the-Counter Medications

Over-the-counter (OTC) pain relievers can also help ease symptoms of infections and allergies. These include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin (ibuprofen) and Aleve (naproxen)

• Fever reducers like Tylenol (acetaminophen)

• Decongestants, including Kovanaze (oxymetazoline), Suphedrine PE (phenylephrine), or Sudafed (pseudoephedrine)

• Antihistamines like Zyrtec (cetirizine) or Claritin (loratadine)

Antibiotics

If your cobblestone throat happens due to bacterial infection, your provider may prescribe antibiotics to kill the bacteria. These medications may include:

• Veetids (penicillin V)

• Moxatag (amoxicillin)

• Permapen (benzathine penicillin G)

• Keflex (cefalexin)

• Cefadroxil (cephalosporin)

• Cleocin T (clindamycin)

How To Prevent Cobblestone Throat

Preventing a cobblestone throat requires you to take steps that help avoid bacterial or viral infections, acid reflux, and allergy attacks. Lifestyle changes and habits that may help include:

• Wash your hands thoroughly and completely, especially if you’re out in public

• Avoid close physical contact with people who are sick

• Avoid smoking

• Clean home surfaces regularly

• Keep windows closed during high-pollen times of the year, especially if you're prone to allergies

• Shower and changing clothes after being outside

• Use hypoallergenic linings on beds, pillows, and blankets

• Sleep with your head elevated

• Manage obesity, as this can raise the risk of GERD and acid reflux

A Quick Review

Cobblestone throat causes stone or pebble-like growths in the tissues of the back of your throat. These bumps often occur alongside pharyngitis (sore throat) and are caused by irritation and inflammation due to excess mucus in your throat.

Allergies, acid reflux, viral and bacterial infections, and smoking can all cause a cobblestone throat. However, home remedies and certain medications can help improve symptoms within a couple of weeks.

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