Children born with a cleft palate, or cleft lip and palate, are likely to experience hearing difficulties in early childhood. In a minority of cases, these difficulties may extend into the early teen years or even adulthood.

The muscles of the palate are directly connected to those that help ventilate the middle ear via the Eustachian tubes. Normal hearing depends on the middle ear being well ventilated, allowing sound vibrations to pass effectively from the outer ear, through the middle ear, and into the inner ear - where they are processed as meaningful sounds.

In children with a cleft palate, the palate muscles are not properly joined at birth. This can interfere with Eustachian tube function, leading to a build-up of mucus in the middle ear - commonly known as "glue ear." This can cause hearing difficulties and, to a lesser extent, increase the risk of middle ear infections.

While glue ear is common in all children, it tends to be more persistent in those with a cleft palate, often continuing from birth through to around age five, and sometimes beyond.

Surgical repair of the palate, which joins the muscles more effectively, usually improves Eustachian tube function. This can lead to better drainage of the middle ear, improved hearing, and fewer ear infections.

Because of the impact on speech and language development, it’s important to monitor hearing closely and watch for signs of ear infections. Early intervention - including temporary hearing aids if needed - can make a significant difference in a child’s development.

A structured protocol for hearing surveillance, developed by the North Thames Cleft Centre, helps guide monitoring through early childhood and into the teen years. It focuses on key stages of speech, language, and educational development.

CLEFT has worked closely with professional partners in low- and middle-income countries to share these multidisciplinary clinic protocols. Through this collaboration, skills have been passed on that benefit not only children with cleft palate but also those with more complex hearing and syndromic conditions.

       

Raouf Chorbachi, Consultant in Audiovestibular Medicine at Great Ormond Street Hospital, pictured (left) with one of his young patients whilst on a training visit to the National Institute for Burns and Plastic Surgery, Dhaka, Bangladesh, and (right) with Mr Rippon, Audiologist, in Dhaka during the same visit in 2023.