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Some of the signs and symptoms of tonsillitis may differ, depending on the cause of the infection. Symptoms can range from mild to severe. When symptoms are acute (severe and sudden), it may indicate a bacterial cause (e.g., strep throat) rather than a viral cause. Viral infections are more common in younger children. When symptoms are chronic, it may indicate an untreated bacterial infection.

Common signs and symptoms of tonsillitis include:

• Sore throat
  
  
• Red, swollen tonsils
  
  
• Swollen lymph nodes (glands) in the neck
  
  
• White spots or coating of the tonsils (may also be yellow or gray in color)
  
  
• Difficulty swallowing (may be evidenced by a refusal to eat or drink)
  
  
• Drooling (may indicate the inability to swallow one’s own saliva)
  
  
• Fever (over 98.6 degrees Fahrenheit or 37 degrees Celsius)
  
  
• Hoarseness or loss of voice
  
  
• Bad breath
  
  
• Headache

Tonsillitis caused by viral infections such as a cold or the flu may also include the following symptoms:

• Stuffy nose
• Runny nose
• Sneezing
• Coughing
• Fatigue
• Muscle aches
• Chills
• Sweats

Tonsillitis caused by the virus that causes mononucleosis (Epstein-Barr virus) may also include the following symptoms:

• Skin rash
• Loss of appetite
• Soft, swollen spleen
• Inflammation of the liver

Parents who observe the following symptoms should obtain immediate medical attention for their child:

• Fever over 100.2 Fahrenheit (37.9 Celsius) in an infant under 3 months old
  
  
• Worsening of symptoms
  
  
• Breathing difficulty
  
  
• Extreme difficulty swallowing
  
  
• Fever clears, then returns