Middle ear disease represents a continuing burden of illness for children of circumpolar regions. Uncertainty in management has been shown to create a barrier to timely and adequate treatment. Consistent intervention strategies were sought for the management of middle ear disease in children of the central Canadian Arctic. The current literature was reviewed using MEDLINE. A consensus document was established in consultation with specialists in community medicine, infectious disease, otolaryngology, pediatrics, and community-based care providers. Definitive recommendations and supportive algorithms have been established for management of middle ear disease in Inuit children.