The diagnosis of a middle ear infection is established by an Ear, Nose, and Throat (ENT) specialist based on the patient's complaints and a comprehensive physical examination. During the examination, the doctor uses a specialized lighted instrument to meticulously inspect the ears, throat, and nose, assessing for any abnormalities in the relevant passages. In cases of acute otitis media, the eardrum typically appears reddened and bulging outwards. In chronic otitis media, findings such as perforation (a hole), retraction (inward pulling), or adhesion (sticking) of the eardrum to middle ear structures may be observed. When eardrum perforation and discharge are present, a culture sample taken from the discharge allows for the identification of the specific bacterial agent causing the infection.