**4. Consequences of OME in CLP**

Children with CLP may suffer recurrent or continuous OME, causing atelectasis, ossicular fixation, and tympanosclerosis [2, 16, 17], which can result in conductive hearing loss of up to 30 decibels (dB). Researchers have previously shown that, regardless of whether they have undergone cleft palate repair surgery, as many as 90% of children with CLP suffer from OME or conductive hearing loss, while 50% suffer from recurrent otitis media [2, 5, 18–20]. In com‐ parison, the prevalence of conductive hearing loss among children without CLP is 12.9%. Although the likelihood of developing OME is reduced after reaching adulthood, it is esti‐ mated that 50% of these children suffer from permanent conductive hearing loss [21, 22]. Additionally, 0.9–5.9% of patients with CLP develop primary acquired cholesteatoma, the probability of which is 100–200 times higher among those without CLP [23, 24].

In addition, sensorineural losses have been ascribed to pathologic changes in the inner ear resulting from inflammation in the middle ear and presumably mediated via the round or oval window [3]. Toxins produced by long‐term inflammation can pass through the round window or the oval window into the inner ear, causing permanent sensorineural hearing loss [17, 25].

Many studies have indicated that although reconstructive surgery for CLP improves linguis‐ tic ability, language development depends on the extent to which hearing ability is main‐ tained [23, 26]. If OME is not treated properly, long‐term hearing loss can negatively influence the language development of children [27]. Hearing loss in children suffering from CLP can also affect their academic comprehension and learning performance [20, 27, 28]. Bess et al. indicated that even if children suffer hearing loss in only one ear, academic performance can still be seriously affected in up to 33% of patients and up to 40% of patients are unable to par‐ ticipate in regular activities or interactions due to hearing loss [29]. It has been found that chil‐ dren with cleft palate are prone to specific psychological problems [30, 31]. Children suffering from this condition may also display behavioral difficulties due to feelings of isolation [29].
