Abstract Background: Otitis media represents a major health concern in Australian Indigenous children ('Indigenous children'), which has persisted, despite public health measures, for over 30 years. Methods: Global searches were performed to retrieve peer-reviewed and 'grey' literature investigating the epidemiology of and risk factors for otitis media in Indigenous children, published between 1985 and 2012. Results: In Indigenous children, the prevalence of otitis media subtypes is 7.1-12.8 per cent for acute otitis media, 10.5-30.3 per cent for active chronic otitis media and 31-50 per cent for tympanic membrane perforation. The initial onset of otitis media in Indigenous children occurs earlier and persists for longer after the first year of life, compared with non-Indigenous children. Indigenous children are colonised by otopathogens more frequently, at younger ages and with a higher bacterial load. Poor community and domestic infrastructure, overcrowding and exposure to tobacco smoke increase the risk of otitis media in Indigenous children; however, the availability of swimming pools plays no role in the prevention or management of otitis media. Conclusion: Despite awareness of the epidemiological burden of otitis media and its risk factors in Indigenous children, studies undertaken since 1985 demonstrate that otitis media remains a significant public health concern in this population.