Cobblestone Throat

What is Cobblestone Throat (Pharyngitis)?

Pharyngitis, sometimes known as cobblestone throat, 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. It may be acute, lasting only a few days to a week, or be a longer-lasting, chronic condition.

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.

If you have a sore throat that lasts several weeks, you may have chronic pharyngitis. In this case, the cause might be an irritant, such as acid reflux, cigarette smoke, or excess mucus.

What Does Pharyngitis Look Like?

Pharyngitis often causes a lumpy, irritated (cobblestone) appearance in the throat. This “cobblestoning” may be accompanied by redness, swelling, and enlarged tonsils.

The exact appearance of a sore throat varies depending on the cause. 

A physical exam helps healthcare providers determine the appropriate diagnosis and treatment plan.

What Causes Pharyngitis?

Many things can cause a sore throat. Pharyngitis is often a symptom of a viral infection, but it can also be caused by bacteria or other conditions.

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)

Bacterial and Fungal Infections

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

Though less common, other bacterial infections can cause pharyngitis. Fungal infections, such as oral thrush, also include pharyngitis as a potential symptom.

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
• Strain (raising your voice for an extended period)

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 repeated exposure to seasonal allergies or a smoking habit. These can cause your throat to remain sore for multiple weeks. 

What are the Symptoms of Pharyngitis?

The main symptom of pharyngitis is a sore throat, and this may be all you notice. But you can also experience additional symptoms, like:

• A lumpy, “cobblestone” appearance to the back of the throat
• Swelling of the throat and/or tonsils
• Redness
• Difficulty swallowing
• Hoarse voice or difficulty talking

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

• Cough
• Fever
• Runny nose
• Swollen lymph nodes
• Headache
• Muscle aches
• Nausea
• Fatigue

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 a high fever, shortness of breath, difficulty swallowing, drooling, or chest pain.

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.

Diagnosis

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

This information may not be enough to determine the exact cause of pharyngitis. In many cases, a throat swab is used to rule out strep throat. Throat swabs can include a rapid strep test and/or a throat culture.

Treatment

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 pain.

For a bacterial infection such as strep throat, your healthcare provider will likely prescribe antibiotics to prevent complications and speed up recovery. It’s important that you 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.

Prevention

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

You can also make non-infectious pharyngitis less likely by being mindful of possible throat irritants. Consider quitting smoking, limiting your consumption of alcohol and acidic foods, and avoiding known allergens.

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 broth — bone broth calms a sore throat and is also high in protein and other essential nutrients.
• Gargle with warm salt water — this is 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 that contain menthol, pectin, zinc, and other ingredients provide temporary relief for 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.

Humid Air

If dry air is contributing 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.

Summary

Pharyngitis, also referred to as sore throat or cobblestone throat, is an inflammation of the back of the throat. It’s a common symptom of certain viral, bacterial, and fungal infections.

In some cases, pharyngitis is chronic, persisting for multiple weeks. Chronic pharyngitis is likely attributed to repeated exposure to an irritant, such as dry air, smoke, or acid reflux.

Depending on the cause, pharyngitis may be accompanied by a fever, cough, and other symptoms. A doctor can provide you with a diagnosis and treatment plan.

Home remedies, such as herbal teas, honey, and lozenges, also help soothe a sore throat.