Assess incidence of conductive hearing loss, ear pathology, and associated communicative disorders in cleft palate patients. Retrospective chart review of 101 patients all treated at a tertiary facility since birth. The median patient age was 19 years old (range 8-25) at last follow-up, 35% female. Median age of cleft palate repair was 16 months (range 12-60). Median number of myringotomy tubes was 3 (range 1-7). Conductive hearing loss (CHL) greater than 20 db PTA was found in 25% of patients at last follow-up. Severity of CHL was mild in 75%, moderate in 21%, and severe in 4%. Cholesteatoma was identified in 5.9%. The mean age at resolution of CHL was 5 years (range 3-19). Risk factors associated with CHL at last follow-up included middle ear surgery (P = 0.016), cholesteatoma (P = 0.003), and 4 or more myringotomy tube insertions (P = 0.030). Associations between CHL and age at cleft repair, speech impairment, or learning disabilities were not found. Children requiring increased number of myringotomy tubes and middle ear surgery and found to have cholesteatoma are at increased risk for long-standing CHL. EBM rating: C-4 Cleft palate children requiring multiple tube insertions should be monitored closely for CHL.