ObjectiveThis article aims to describe the rates of middle ear disease in Aboriginal children living in metropolitan Adelaide. MethodsData from the Under 8s Ear Health Program (population-based outreach screening) were analysed to identify rates of ear disease and the referral outcomes for children identified with ear conditions during screening. ResultsIn total, 1598 children participated in at least one screening between May 2013 and May 2017. Males and females were equally represented; 73.2% had one or more abnormal findings on otoscopy at the first screening visit, 42% had abnormal tympanometry, and 20% registered a “fail” on otoacoustic emission testing. The referral pathway for children with abnormal findings included referrals to their GP, Audiology, and Ear Nose Throat (ENT) Departments. Also, 35% (562/1598) of the children screened required referral either to a GP or Audiology, and 28% of those referred (158/562) or 9.8% (158/1598) of the total number of children screened required further ENT management. ConclusionsHigh rates of ear disease and hearing problems in urban Aboriginal children were detected in this study. Existing social, environmental, and clinical interventions need to be evaluated. Closer monitoring including data linkage may assist to better understand the effectiveness, timeliness, and challenges of public health interventions and follow-up clinical services to a population-based screening program. Implications for Public HealthAboriginal-led population-based outreach programs such as the Under 8s Ear Health Program augmented by seamless integration with education, allied health and tertiary health services should be prioritised for expansion and continued funding.