What is Cobblestone throat?

in:Coronavirus COVID-19published:03 Dec 2020, last updated:09 Mar 2026

What is cobblestone throat?

Cobblestone throat refers to "lumpy" or rough surface at the back of the throat (see image as example). Cobble stone throat is a potential finding on clinical examination when a doctor examines the back of the throat. You may have heard this in the context of the recent Flu outbreak. This is a finding associated with Pharyngitis, that is inflammation of this area of the throat. It can lead to swelling of the lymphatic tissue (a component of the immune system) deep in this area that leads to the rough appearance on the surface. Possible causes for cobblestone throat include Infections, Allergies, Irritants, Acid reflux, and others. Read on to find out more about each of these.

What are the causes of cobblestone throat?


1. Infection

These are a common cause of cobblestone throat, out of which viral infections are the commonest type as opposed to others such as bacterial and/or fungal infections. Often a period of rest and actively hydrating with lots of water will provide great relief for most viral infections and antibiotics are not useful. However, if the symptom persists for more than 2-3 days of rest and hydration, it would be pertinent to get an examination with your doctor for a check-up to ensure there are no features of certain severe viruses (such as Ebstein Barr) and/or others such as bacteria, and treatment would be tailored accordingly (may include antibiotics, depending on examination findings)


2. Allergy

Often wake up in the morning with a runny or blocked nose, with sensations of mucus trickling backwards down your throat (post-nasal drip)? Or perhaps you develop these symptoms on exposure to certain triggers like dust or cold air? This may mean you have allergic rhinitis, another cause of "cobblestoning" of the throat. Here, the underlying cause being the allergy for the inflammation and swelling of tissue at the back of your throat. This may need specific treatment such as anti-histamine tablets and/or nasal sprays which your doctor can prescribe.


3. Irritants

Prolonged/excessive exposure to airborne irritants can also lead to inflammation and cobblestone throat, such as smoking, vaping and/or air pollution.


4. Acid 

Ever feel like there may be sourish fluid from your tummy that finds its way back into your mouth, or a burning sensation in your throat/tummy? These are possible symptoms of gastro-oesophageal reflux disease (GERD) which can also be a cause for inflammation and irritation in the throat. You can read more about GERD at the link above!


5. Thicker mucous

This would be diagnosis of exclusion, and you would need to have a review with your doctor to ascertain none of the other possible causes are leading to the irritation. With thicker mucous, there are reports that irritation in the throat can develop. This may arise as a result of inadequate hydration and/or certain medications. Once again, a period of rest and hydration may provide relief, but if symptoms persists for more than 2-3 days, do visit your doctor for an examination.


6. Others 

Finally, as with most medical issues, occasionally there can be more insidious causes of a given finding which your doctor would look out for. In the case of cobblestone throat, these include certain growths and or blood cell disorders that can be and early sign of potentially serious diseases.


What to do if you have cobblestone throat?

Ultimately, as you probably gathered above, a period of rest and increased water intake will provide significant relief of cobblestone throat arising from most common causes. 

However, if you find your symptoms are persisting more than 2-3 days, or developing with other concomitant problems such as painful lumps in the neck, ear discomfort, or blood in your phlegm, do have an early review with your family doctor. Depending on his findings, he would be able to offer tailored therapy or, if required, a referral to a specialist colleague for further assessment. The latter may be a specialist from Otolaryngology (or "Ear, Nose, Throat (ENT)") for further evaluation and consideration if a scope may be required.

For greater convenience, you may consider having an initial consultation online via video call with a doctor to assess whether you really need to make that trip down. Several of these applications also provide specialist referrals and/or medication delivery to your home as well.

Author's Profile
GENERAL PRACTICE
Biography

Adj. Assistant Professor. Dr. Dinesh Visva Gunasekeran MBBS, PhD  is a licensed general practitioner (GP) in Singapore with a passion for sustainable initiatives that improve the quality, affordability, and accessibility of healthcare. Dr. Dinesh has managed complex initiatives from health promotion/community-based screening programs in underprivileged populations, to multinational health technology research spanning across industries, by leading multidisciplinary teams to execute aligned objectives. He was conferred the NUS Student Leadership award for multidisciplinary collaborations across faculties of Medicine, Nursing, Pharmacy and others to organise technology-enabled grassroots health promotion campaigns and free annual health screenings for underprivileged communities in Kallang, Geylang, Chinatown, and Macpherson.

Link to more details -  FACES OF CO-OPERATORS: DR DINESH VISVA GUNASEKERAN, A FRONTLINER WITH A VISION 

Credentials And Achievements

Awards:  
1. 2019 NUS Young Alumnus (Medicine) of the Year, National University of Singapore (NUS); 
2. Commonwealth Fellow (Innovation), British High Commission (BHC), Singapore; 
3. National Youth Fund award, National Youth Council (NYC), Singapore.
4. Best Paper Award (Education), issued by Singapore General Hospital (SGH) at the  Singhealth DUKE-NUS Congress 2018. 
5. Best Paper award (1st Runner up), issued by  Tan Tock Seng Hospital at the 2018 International Ophthalmology Congress (IOC), Singapore  
6. WHBRS Distinction award 2014 (Open Category), issued by Wong Hock Boon Research Symposium (WHBRS), Singapore. 
7. 2014 TTSH IOC 1st Place (Open Category) award, issued by Tan Tock Seng Hospital (TTSH) at the 7th International Ophthalmology Congress (IOC) by NHGEI, TTSH. 
8. NUS Student Leadership Award (Individual Leadership category)

10 recent publications out of >50:
1) Gunasekeran DV. Technology and chronic disease management. Lancet Diabetes Endocrinol. 2018 Feb;6(2):91. Article.
2) Gunasekeran DV. Invited Commentary: Treating the Patient with Uveitis as an Individual – Not a Disease. JAMA Ophthalmol. 2019;137(2):206-207. Article.
3)  Gunasekeran DV* and Liu ZH*, Tan WJ, Koh J, Cheong CP, Tan LH, Lau CS, Phuah GK, Manuel ND, Chia CC, Seng GS, Tong N, Huin MH, Dulce SV, Yap S, Ponampalam K, Ying H, Ong MEH, R P. Safety and Efficacy of telereview in patients with Abdominal Pain Using Video Consultation: a randomised controlled trial evaluating digital telereview (SAVED). J Med Internet Res. e-pub ahead of print. Article.
4)  Weiling LL, Ming Kai AC, Gunasekeran DV. Digital health for patients with chronic pain during the COVID-19 pandemic. Br J Anaesth. 2020 Aug 10. Epub ahead of print. Article.
5) Gunasekeran DV, Wong TY. Artificial Intelligence in Ophthalmology in 2020: A Technology on the Cusp for Translation and Implementation. Asia Pac J Ophthalmol. 2020;9(2):61-66. Article.
6)  DS Ting, Gunasekeran DV, Wickham L, TY Wong. Next generation telemedicine platforms to screen and triage. Br J Ophthalmol. e-pub ahead of print. Article.
7)  Agrawal R* and Gunasekeran DV*, Grant R, Agarwal A, Onn MK, Nguyen QD, Pavesio C, Gupta V, COTS-1 Study Group. Clinical features and outcomes of patients with TB uveitis treated with anti-tubercular therapy (ATT) in COTS-1. JAMA Ophthalmol. 2017 Dec;135(12):1318-1327. Article.
8)  Z Liu, M Ng, DV Gunasekeran, H Li, K Ponampalam, R Ponampalam. Mobile technology: Usage and perspective of patients and caregivers presenting to a tertiary care emergency. World J Emerg Med. 2020;11(1):5-11. Article.
9)  Chia KJW, Gunasekeran DV, Laude A. The Impact of Switching Anti-Vascular Endothelial Growth Factor Therapy in the Management of Exudative Age-Related Macular Degeneration. Ophthalmic Surg Lasers Imaging Retina. 2017 Oct;48(10):859-869. Article.
10)  Bansal S, Gunasekeran DV, Ang B, Lee J, Khandelwal R, Sullivan P, Agrawal R. Controversies in Pathology and Management of Hyphema. Surv Ophthalmol. 2016 May-Jun;61(3):297-308. Article

Financial Declaration

DVG reports equity investment in AskDr, Doctorbell (acquired by Mobile Health Network Solutions, NYSE:$MNDR), Healthlink Protocol, and VISRE.

Accepted Insurance

CHAS, Healthier SG, Cigna, MHC, etc

References
  1. La Mantia I, Andaloro C. Cobblestone Appearance of the Nasopharyngeal Mucosa. Eurasian J Med. 2017 Oct;49(3):220-221. doi: 10.5152/eurasianjmed.2017.17257 Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC5665636/
  2. Inui G, Tomita K, Yamasaki A. Cobblestone Throat in a Younger Patient Infected with the Omicron Variant of the SARS-CoV-2 Virus. Am J Trop Med Hyg. 2023 Jun 26;109(2):221-222. doi: 10.4269/ajtmh.22-074. Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC10397436/
  3. Brar S, Watters C, Watson N, Birchall M, Karagama Y. Ear, nose and throat (ENT) manifestations and complications of reflux. Frontline Gastroenterol. 2022 Jun 7;13(e1):e57-e64. doi: 10.1136/flgastro-2022-102184. Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC9234721/


Comments
@Ritusha
I have cobblestone throat since 3 months and it is not going away..... can you tell me how to fix it??
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