From the Guidelines
Cobblestoning in the pharynx is a condition characterized by a bumpy, irregular appearance of the back of the throat, resembling a cobblestone street, which is often associated with postnasal drip, chronic allergies, or persistent infections. This condition occurs when lymphoid tissue in the throat becomes enlarged and inflamed, creating raised, rounded bumps on the pharyngeal wall, as noted in the physical examination of patients presenting with symptoms compatible with rhinitis 1. The cobblestone appearance develops as a result of the body's immune response, where lymphoid follicles become hyperplastic (overgrown) due to chronic stimulation.
Key Characteristics of Cobblestoning
- Bumpy, irregular appearance of the back of the throat
- Enlarged and inflamed lymphoid tissue
- Raised, rounded bumps on the pharyngeal wall
- Associated with postnasal drip, chronic allergies, or persistent infections ### Common Causes and Associations
- Allergic rhinitis
- Chronic sinusitis
- Chronic pharyngitis
- Postnasal drip ### Symptoms and Treatment
- Associated symptoms: sore throat, sensation of something stuck in the throat, or excessive mucus
- Treatment focuses on addressing the underlying cause, such as managing allergies with antihistamines or nasal steroids, treating infections with appropriate antibiotics if bacterial in nature, or reducing irritants like tobacco smoke, as suggested by the diagnosis and management of rhinitis 1.
Importance of Accurate Diagnosis
Accurate diagnosis and management of the underlying condition are crucial to improve the appearance of the pharynx and alleviate associated symptoms, highlighting the need for a comprehensive physical examination and diagnostic testing, such as skin testing for specific IgE antibodies 1.
From the Research
Definition of Cobblestoning in the Pharynx
Cobblestoning in the pharynx refers to a specific appearance of the pharyngeal mucosa, characterized by a cobblestone-like texture. This appearance is often associated with certain conditions, including:
Characteristics of Cobblestoning
The cobblestoning appearance is typically observed during endoscopic examinations, such as nasendoscopy or laryngoscopy. It is often accompanied by other signs, including:
- Thickening of pharyngo-laryngeal mucus 2
- Arytenoid edema/hyperemia 2
- Nodular thickening/true vocal cord edema 2
- Hypertrophy of the posterior commissure 2
- Subglottic edema 2
Diagnostic Techniques
Cobblestoning in the pharynx can be diagnosed using various techniques, including: