Background: Debate continues about the recovery of eustachian tube (ET) function after CP repair. It has been strongly recommended that children with cleft palates should receive aggressive treatment of middle ear dysfunction to prevent hearing loss and speech delays. Objective: To investigate the need for VT insertion in cleft palate patients repaired by modified Furlow palatoplasty versus two flaps palatoplasty. Patients and methods: The study included 72 cleft palate patients who were divided into 2 groups. Group1 (42) patients were repaired by modified Furlow Z-plasty operation. Group 2 (30) patients subjected to two flaps palatoplasty. Eustachian tube function was evaluated preoperatively and postoperatively at 1, 3, 6, 12 months. Results: Palatoplasty directly improved ET dysfunction. Modified Furlow showed early improvement at 3 months postoperatively (p value 0.004) but has no superiority after one year over two flaps palatoplasty. 34.7% of cases spared from VT insertion and its complication. Conclusion: palatoplasty significantly improves ET function. Conservative management of middle ear effusion is recommended for CP patients instead of prophylactic tube insertion.