Viral tonsillopharyngitis (infection of the tonsils and throat caused by a virus)

Usually mild to moderate throat pain and little or no fever

Usually a runny nose and/or cough

Throat and tonsils that are slightly to very red and that may be coated with a white discharge or pus

Sometimes one or two enlarged lymph nodes in the neck

A doctor’s examination alone

Strep throat

Often severe throat pain and fever

Rarely a runny nose or cough

Often a very red throat and tonsils that are coated with a white discharge or pus

Usually one or two tender, enlarged lymph nodes in the neck

Testing of a sample taken from the throat with a swab

Mononucleosis (caused by the Epstein-Barr virus)

Often moderate to severe throat pain, high fever, and constant fatigue but no cold symptoms

Usually in adolescents or young adults who have never had mononucleosis

Often a very red throat and tonsils, coated with a white discharge or pus

Typically many enlarged lymph nodes on both sides of the neck and sometimes an enlarged spleen detected during a doctor's examination

A blood test for antibodies to Epstein-Barr virus

Abscess‡

Severe throat pain, often fever, and no cold symptoms

Sometimes a muffled voice that sounds as if a hot object is being held in the mouth ("hot potato" voice)

Throat and tonsils that may be slightly to very red

Typically substantial swelling on one side of the throat, detected during the examination

Usually removal of pus with a needle (for diagnosis and treatment)

Sometimes CT of the neck

Epiglottitis‡ (infection of the epiglottis—the small flap of tissue that covers the opening to the voice box, or larynx)

Severe throat pain and difficulty swallowing that begin abruptly

In children, often drooling and signs of severe illness (such as little or no eye contact, failure to recognize parents, and irritability)

Sometimes (more often in children) respiratory symptoms, including

• Breathing rapidly (tachypnea)

• Squeaking when breathing in (stridor)

• Sitting upright and leaning forward, with the neck tilted back and jaw thrust forward (to try to increase the amount of air reaching the lungs)

A throat that typically appears normal seen during the examination with a laryngoscope (however, examination can be dangerous and may not be advisable)

For most children and for adults who appear seriously ill, flexible fiberoptic laryngoscopy (insertion of a thin flexible tube into the throat to directly view the epiglottis), done in operating room

Sometimes for people who do not have all the symptoms of epiglottitis and who do not appear seriously ill, x-rays of the neck