Management of the middle ear in patients with cleft palate

Middle ear pathology, most commonly otitis media with effusion accompanied by hearing loss, is almost universal in patients with cleft palate. This poses further challenges to an already complex patient population. Ventilation tube insertion provides an immediate solution, in theory, to middle ear effusion and pressure equalization. In practice, optimal management of the middle ear in patients with a cleft palate is still controversial, with inconclusive evidence to guide when, and even if, to place ventilation tubes. A review of current evidence will be presented regarding pathophysiology and incidence of middle ear disease in this population, as well as considerations to guide management.