Purpose: Accurate evaluation of grommet position, patency and infection is necessary for optimal postoperative ENT care, especially in rural and remote communities with limited specialist access. This study aims to evaluate inter-rater reliability of JMOs evaluating grommet status. Methodology: Retrospective analysis of otoscopic images of children with tympanostomy from telehealth programs in NT and QLD from 2011-2019 was conducted. Images featuring grommets were independently reviewed by 3 JMOs and 1 accredited registrar (reference standard). Grommets were classified as in-situ and patent, insitu and blocked, or extruded. Agreement metrics, including % agreement and kappa statistics, were calculated to assess consistency of JMOs’ detection of grommet status compared to the reference standard. Results: Among 300 grommets, 61% were identified by a senior registrar (reference standard) as in situ and patent, 26% in situ and blocked, and 13% extruded. JMO and registrar agreement for grommets in situ was 82% (95% CI: 78-85%), with kappa value of 0.77 (substantial agreement). For grommets identified as in situ and patent, agreement rose to 89% (95% CI: 85-92%) with kappa of 0.88. Detection of blocked grommets showed lower agreement of 66% (95% CI: 58-73%) and kappa of 0.53 (moderate agreement). Conclusion: JMOs perform well in identifying patent grommets but show lower accuracy in identifying blocked grommets, which could delay appropriate care in underserved rural and Indigenous communities. Integrating artificial intelligence-driven analysis in digital otoscopy could offer JMOs real-time feedback on grommet status, improving diagnostic accuracy, enhance patient education, and healthcare equity in rural and remote settings.