Middle ear problems in patients with cleft palate have for a long time received insufficient attention. The present study was designed to evaluate middle ear function in 56 children with cleft palate and in a control group of 50 children without cleft palate. The age ranging between 5 and 14 years was similar in both groups. All children underwent routine otoscopic examinations of ear, nose and throat, and were also examined using the Madsen acoustic impedance audiometer. Four major parameters (static compliance, middle ear pressure, acoustic stapedius reflex and Eustachian tube function) were analyzed. It was found that the negative middle ear pressures were higher and the static compliance, which reflected the elasticity of the conducting mechanism of the middle ear, was poorer in children with cleft palate than in the controls. The proportion of children with cleft palate who showed the presence of the acoustic stapedius reflex was also lower than in the control children. Children with cleft palate have a limited ability to actively open the Eustachian tube by swallowing, as evidenced by a poor ability to equilibrate applied positive or negative middle ear pressure. A multidisciplinary approach should be adopted for the complete overall rehabilitation of children with cleft palate. Plastic surgeons to whom most of the treatment is entrusted should be concerned not only with achieving palatal function and acceptable speech, but also with the various other problems associated with cleft palate, especially those affecting the middle ear.