A doctor will check to see if pulling the earlobe gently or pushing the tragus, the small flap of ear just in front of the canal opening, causes pain. If these symptoms are present, you can be pretty sure it's an external infection and not otitis media. The doctor can often make the diagnosis simply by looking in the ear with an otoscope (an instrument for examining the ear).
A lab culture may be ordered to identify the particular organism only if the first treatment recommended by the doctor doesn't seem to be working.
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