Aims To assess outcomes of endoscopic push-through myringoplasty using tragal cartilage in Aboriginal patients managed in remote Northern Territory settings, and to document the technical approach, Practical suitability and complication profile. Methodology Between May 2024 and October 2025, 43 myringoplasties were performed using an endoscopic technique with a 30-degree oto-endoscope. The procedure included posterior tragal infiltration, endoscopic canal preparation, perforation edge refresh, under-surface refashioning, and placement of a tragal cartilage island graft with peripheral perichondrium, cartilage facing outwards. Dry gelfoam supported the graft and ciprofloxacin-soaked gelfoam was placed in the canal. Patients were reviewed at 2 weeks, 4–6 weeks and approximately 2 months with audiology. Follow-up was available for 17 of 43 patients. Primary outcome was graft integrity. Secondary outcomes included complications and hearing improvement. Results Of 17 patients with follow-up, 16 (94%) achieved an intact graft. One patient had complete graft failure. One case of fungal otitis externa was treated successfully. Residual perforation occurred in two patients. Most patients reported hearing improvement consistent with a reduced conductive component. No cases of ossicular injury, cholesteatoma or major adverse events were recorded. Conclusion Endoscopic push-through myringoplasty using tragal cartilage provides a high graft-take rate and low complication rate in Aboriginal patients treated in remote outreach environments. The technique offers excellent visualization in ears with anterior overhang and is suitable for resource-limited settings. Longer-term audiometric follow-up is recommended.