Cleft lip and palate is one of the most common congenital head and neck malformations with an estimated incidence of 1,25 in 1000 newborn children. Because this complex and multidimensional phenomenon affects one's appearance, swallowing, feeding, hearing, speech, voice, and overall quality of life, its successful management requires multidisciplinary teamwork. Cleft palate is associated with Eustachian tube dysfunction which leads to secretion of fluid into the middle ear space. Inadequate ventilation of the middle ear results in persistence of fluid causing otitis media with effusion. This type of middle ear pathology occurs in about 90% cases of cleft palate and is accompanied by conductive hearing loss. Despite the fact that the insertion of ventilation tubes into the tympanic membrane is the most common surgical choice for treating otitis media with effusion, its effectiveness and long term benefit is still controversial. The objective of this paper is to provide a review of current studies and recent knowledge about mechanism of pathophysiology and characteristics of hearing loss in cleft palate population including pros and cons of different intervention approaches. Acknowledging long term hearing outcomes in patients with cleft palate and their implications is incredibly important for attaining the best possible quality of life, therefore, the purpose of this paper is to express the need for regular audiological follow ups all through childhood, adolescence and adulthood.