Background: The Deadly Ears Program supports Aboriginal and Torres Strait Islander communities across Queensland to reduce the impact of middle ear disease. Myringoplasty aims to give children a clean, dry ear. Our program delivers a culturally safe surgical experience for families on Country where clinically appropriate. Methods: A retrospective cohort study of Indigenous children undergoing myringoplasty through the Deadly Ears program was conducted. Patient and Deadly Ears program demographics reported include age, engagement with Deadly Ears across home and other communities, and previous ENT surgeries. Surgical outcomes reported include TM closure, hearing improvement, and operative techniques. A systematic literature review using PubMed and Embase (to 20 October 2025) identified peer-reviewed studies of myringoplasty outcomes for Indigenous children performed outside of major hospitals. Results: 104 Indigenous children underwent 135 myringoplasties by Deadly Ears across 9 communities over 10 years. Surgical and audiological follow-up data was complete for 123 (91%) cases. Over 60% of patients had TM perforation closure, perforation improved in 75%, and 65% of children’s hearing improved. Other studies of Indigenous people having myringoplasty surgery in Community identified 2 paediatric-specific and 5 studies of all ages. Reported TM closure rates were 39–82.7%, while 29–80% of patients experienced hearing improvement. Conclusion: This study demonstrates strong community engagement achieved by Deadly Ears with comprehensive patient follow up higher than reported in other studies (21.5 – 78%). Surgical and hearing outcomes for patients from myringoplasty by Deadly Ears were within previously reported ranges for other outreach programs but do fall below myringoplasty performed in urban hospitals (88.5% - 90%). These results will guide our program’s future medical decision making while we continue to prioritise culturally safe and locally delivered care.