Objective <p>To assess the functional status of the middle ear in children with cleft palate and to evaluate the grade of tympanic membrane retraction using Sade and Tos classification.</p> Method <p>A one-year cross-sectional study was conducted involving 43 children with cleft palate. Each child underwent clinical assessment followed by evaluation of middle ear function using Pure Tone Audiometry and Tympanometry. Tympanic membrane retraction was graded through otoendoscopic examination using the Sade and Tos classification. The data were analyzed to determine the grade of tympanic membrane retraction, middle ear pressure, and the degree of hearing loss.</p> Results <p>Type B tympanogram was the most commonly observed finding. The mean Pure Tone Audiometry threshold for the right ear was 26.79 ± 9.13 dB, and for the left ear, 29.73 ± 9.20 dB. No statistically significant association was found between cleft type and tympanometry results in either ear (<i>p</i> &gt; 0.05). The most common tympanic membrane retraction observed in the pars tensa was Sade grade 2 in both ears. Pars flaccida retraction was noted in only a few cases. There was no statistically significant difference in the number of cases with varying grades of tympanic membrane retraction in the right and left ears (<i>p</i> &gt; 0.05).</p> Conclusion <p>Children with cleft palate are at increased risk for middle ear disease. Regular endoscopic and audiological monitoring, along with timely intervention, is essential to prevent long-term auditory deficits. Consistent evaluation is crucial for proper speech development and academic performance. This study highlights the importance of multidisciplinary care—integrating otolaryngologists, audiologists, and speech therapists—to improve hearing outcomes and the overall quality of life for these children.</p>