For nearly a century, the Royal Flying Doctor Service (RFDS) has embodied the frontier spirit of Australian medicine, bringing critical care to patients scattered across the vast and unforgiving interior. Yet amid its legendary retrievals of trauma and cardiac cases lies an untold story: the management of ENT emergencies in some of the most isolated regions on earth. This presentation traces the evolution of ENT care through the lens of the RFDS, from its early days of bush pilots and pedal radios to the modern era of airborne intensive care. Drawing on historical archives, retrieval reports, and documented RFDS cases—including paediatric airway obstruction from laryngomalacia, deep neck space infection, epiglottitis, and complicated mastoiditis—it highlights how ENT pathology has repeatedly tested the ingenuity and courage of clinicians working against distance, weather, and time. Through these case narratives, we explore how geography reshaped the hierarchy of airway management: when no ENT surgeon is within a thousand kilometres, generalists, retrieval physicians, and pilots become the de facto airway team. The talk also examines the changing burden of chronic ear disease and hearing loss in remote Indigenous communities, and the RFDS’s evolving role from crisis response to proactive outreach, screening, and tele-ENT programs. By weaving together medical history, aeromedical innovation, and the human stories behind life-saving flights, this presentation positions the RFDS not merely as a retrieval service but as an enduring extension of Australia’s ENT care network. It is a testament to how resilience, improvisation, and compassion overcame the tyranny of distance—and how the battle for the airway has always, quite literally, taken to the skies.