<p>Otitis media is a common infectious disease and a major cause of antibiotic use and preventable hearing loss, particularly in low- and middle-income countries. Increasing antimicrobial resistance complicates empirical treatment, making local surveillance of causative organisms and resistance patterns essential. This study aimed to identify prevalent bacterial pathogens and their antibiotic susceptibility profiles among otitis media cases at a tertiary care hospital in Islamabad, Pakistan. A retrospective, cross-sectional laboratary-based study was conducted using microbiological records from September to December 2025. Ear swab specimens from patients of all ages with suspected otitis media were analyzed. Bacterial identification was performed using standard culture and biochemical methods, while antibiotic susceptibility testing followed the Kirby Bauer disk diffusion method according to Clinical and Laboratory Standards Institute(CLSI) guidelines. Descriptive statistical analysis was used to summarize organism distribution and resistance patterns. Out of 169 samples, 82 (48.5%) showed showed bacterial growth observed. <i>Staphylococcus aureus</i> (S. aureus) (27.8%) was the most frequently isolated organism, followed by <i>Pseudomonas aeruginosa</i>(P. aeruginosa) (24.7%). Methicillin-resistant <i>S. aureus</i> (MRSA) constituted 37.2% of all <i>S. aureus</i> isolates. High resistance rates were observed against ampicillin (62.3%), clindamycin (50.0%), and ciprofloxacin (47.0%). Low resistance was noted for piperacillin–tazobactam (8.8%), amikacin (11.0%), gentamicin (12.7%), and imipenem (14.0%). All MRSA isolates were sensitive to vancomycin. <i>S. aureus</i> (including MRSA) and <i>P. aeruginosa</i> were the predominant pathogens causing otitis media, with substantial resistance to commonly used first-line antibiotics. Regular local antibiogram surveillance is crucial to guide effective empirical therapy and support antimicrobial stewardship.</p>