Background: Otitis media with effusion (OME) is a collection of non-purulent fluid in the middle ear space; it is almost universal in children with cleft palate. Cleft palate (CP) is among the most common congenital malformations, with an overall incidence of around 1 in 700 individuals. Surgical closure of the cleft palate may lead to improvement in the audiological status of the patients, but whether early surgical correction can improve the middle ear status in CP children remains open for debate. Aim: A meta-analytical study to evaluate and compare the outcome of ventilation tube insertion versus conservative management in management of otitis media with effusion accompanying cleft palate. Methods: A review process was used to assess eligible studies drawn from included published medical articles about conservative management versus ventilation tube insertion in children with otitis media with effusion accompanying cleft palate through searching the Medline data base (www.pubmed.com) and Cochrane library. Then Data were extracted and analyzed from the included studies. Results: 30 relevant articles were found, by application of inclusion criteria 8 articles were found meeting the inclusion criteria and could undergo Meta-analysis. Our results have shown that OME in children with repaired cleft palate can be managed satisfactorily without routine use of ventilation tube (VT). The presence of OME does not lead to long term complications in all patients. Hearing impairment due to OME can be satisfactorily treated with hearing aid (HA) in a majority of children. VT need to be inserted only if the child is not compliant with using a HA or develops recurrent suppurative otitis media. Patients should be followed-up closely for OME to prevent complications. Conclusion: Routine use of ventilation tube in CP patients should be discouraged; instead Treatment should be based on the need and willingness of the children and their parents. Also with respect to individual bases such when the child is proved to have OME and hearing loss that affect child language and speech development. Insertion of ventilation tubes should be offered as an alternative to hearing aids or conservative management by close otological and audiological follow up.