Aims: To report utilisation rates and available audiological outcomes among Australian Indigenous cochlear implant (CI) recipients, and identify access barriers to CI and hearing rehabilitation. Method: Systematic search of Medline, Web of Science, Embase, CINAHL and grey literature (September 2025) yielded 855 records. Studies reporting utilisation, outcomes, complications, and follow-up/access to CI amongst Indigenous Australians were screened. Results: Only three studies met inclusion criteria; nine additional grey literature sources were identified. While a Western Australian paediatric CI cohorts showed Indigenous children comprised 3% of recipients (4/118), nationally, only 1.8% (145/8,200) of Indigenous hearing device users have CIs, despite 43% of Indigenous people aged 7+ having measured hearing loss. Critically, none of the included studies reported Indigenous-stratified CI outcomes. First hearing device fittings typically occur at 3–6 years in Indigenous children versus under 1 year in non-Indigenous children. Major access barriers identified included under-screening, geographic isolation from tertiary CI centres, fragmented care pathways, and concerns about cultural safety. The evidence suggests that barriers accumulate across the entire hearing-care continuum, rather than being confined to CI services. Adult Indigenous audiology services remain particularly underutilised despite high prevalence of hearing-related diseases. Conclusion: Indigenous-specific CI outcome data are essentially absent despite a documented substantial burden of severe and profound hearing loss in First Nations people. Indigenous-specific effectiveness evidence is needed to ensure equitable benefit of CI across all Australian population groups. Urgent priorities include Indigenous-led research, and data linkage to track outcomes. Strengthening ear-health services and routine screening is essential to ensure equitable CI access for Aboriginal and Torres Strait Islander peoples.