Indigenous Australian Communities have shouldered one of the largest burdens of otitis media and hearing loss in the world for over 100 years. Reports from the late 1800s describe persistent otorrhoea, TM perforation and hearing impairment in remote First Nations children. Throughout the 20th century, the widespread nature of chronic, severe and recurrent middle ear disease in Community was confirmed by sporadic outreach service, and this was closely linked to overcrowding, limited medical care access and socioeconomic disadvantage. Indigenous ear-health services have evolved from early mission-based care to all-encompassing ENT outreach. In the 1970-80s, school hearing surveys and opportunistic mobile clinics played pivotal roles in identifying children with middle ear disease. The 2000s saw the emergence of early multidisciplinary outreach models, including the Northern Territory Outreach Hearing Health Program, South Australia’s Aboriginal Ear Health Campaign and Queensland’s Deadly Ears Program. These programs pioneered the use of portable audiology devices, digital otoscopy, telehealth and on-Country surgical services. As outreach has evolved, the focus has shifted from medical officer/government directed care to one of collaboration with Community, aiming to amplify the Indigenous voice in improving health outcomes, and provide a more patient-centred approach. Past services were sporadic and resource-limited, while sustainability and Community engagement are the current cornerstones of care. Collaboration between Aboriginal Community Controlled Health Organisations (ACCHOs), state health departments and ENT specialist teams have improved access, continuity and sustainability of care. Tracing the historical evolution of remote outreach services contextualises the epidemic of middle ear disease, and underscores the importance of ongoing, nation-wide investment in culturally safe, accessible care to drive equitable health and hearing outcomes for Indigenous Communities.