Abstract Background The use of telehealth during the COVID-19 pandemic has emerged as both a necessary and significant tool in the provision of safe and timely healthcare in the field of otolaryngology. Increased access to specialist care in a regional setting is an additional benefit. Variation in diagnostic accuracy of telehealth consultations may affect diagnosis and management. Therefore, our aim is to determine the diagnostic accuracy of telemedicine for otolaryngology in an Australian regional setting. Methods Retrospective review was conducted for all patients who received an initial telemedicine appointment over a 7 month period during the COVID-19 pandemic in regional Victoria, Australia. Data was collected regarding initial diagnosis and management from telemedicine consultations, subsequent physical appointment findings and management and intraoperative findings. Statistical analysis was performed using Prism (version 8.0, GraphPad). Results Two hundred and fifty-nine patients were included. The most common conditions referred were for consideration of tonsillectomy with or without adenoidectomy (44.0%). Overall diagnostic accuracy of the initial referrer was 63.3% and for telephone appointments it was 81.9%. Concordance of recommended treatment plans between telephone and physical appointments was 96.9%. Conclusion There are significant benefits of phone only telemedicine within the context of a global pandemic which were compounded by a regional setting. Paediatric patients were found to be of highest benefit for telemedicine with high diagnostic accuracy and concordance of treatment plans.