OBJECTIVES: Middle ear disease is a frequent problem in young children with cleft palate (CP). Less is known about otological status in the adolescent CP population. The aim of this study is to provide an overview of current knowledge in the literature concerning the aetiology of middle ear disease in CP patients and the middle ear status of older children with CP, and to compare the situation in our centre to this background through an assessment of the otological status of patients in our CP population. MATERIAL AND METHODS: A literature review was conducted to summarise current knowledge about middle ear status in CP patients. A retrospective analysis was performed of the medical records of 20 CP patients between the ages of 10 and 15 who were treated and followed at the University Hospitals Leuven. The available otological data, otoscopic findings, information about hearing and surgery performed was collected for each patient when aged three and above ten years. RESULTS: Current knowledge indicates that middle ear function improves as CP patients get older. In our study, otoscopic appearance was acceptable in 63% of ears of children aged over ten years of age. Otitis media with effusion (OME) was far less frequent above this age than around the age of 3, with a decrease from 50% to 13% of all ears. Above the age of 10, tympanic perforations were present in 13% of ears and retraction of the tympanic membrane in 23%. CONCLUSIONS: Despite a very high incidence of OME in young CP patients, the long-term otological prognosis is not necessarily sinister. A favourable natural evolution, diligent otological follow-up, early diagnosis and treatment of middle ear disease with the use of tympanostomy tubes are the likely contributors to the acceptable otological result in older CP patients.