Atipas K.Ungkanont K.Tanphaichitr A.Vathanophas V.Wannarong T.Mahidol University2026-06-222026-06-222026-01-01Laryngoscope (2026)0023852Xhttps://repository.li.mahidol.ac.th/handle/123456789/117472Objectives: To characterize morphology and opening pattern of the Eustachian tube (ET) in children with and without cleft palate (CP), and to examine the associations between endoscopic findings and otologic outcomes. Methods: This cross-sectional study included children aged 4–12 years with CP (n = 25) and without CP (n = 25) who underwent transnasal endoscopy for clinical indications. Endoscopic evaluation assessed adenoid, torus tubarius, tubal tonsil, discharge at the opening, ET opening visibility and movement, and the Eustachian Tube Inflammation Scale (ETIS). Findings were compared between groups using the chi-square or Fisher's exact test. Associations between endoscopic findings and middle ear outcomes were analyzed using Spearman's rank correlation. Results: Torus tubarius anomalies were more frequent in children with CP than in non-CP children (52% vs. 20%, p = 0.02), with all anomalies involving the posterior lip of the torus tubarius. Copious discharge at the ET opening was observed more frequently in children without CP (p = 0.04). Adenoid size, dynamic ET opening visibility, and ETIS grades showed significant correlations with both middle ear status and the rate of myringotomy in children with CP, whereas discharge-related findings were more associated with middle ear status in children without CP. Conclusion: Transnasal endoscopy provides important insights into ET opening in children with CP, in whom torus tubarius anomalies are common. Associations between adenoid size, ET lumen visibility, and middle ear disease highlighted the potential role of ET opening assessment for individualized management in this population. Level of Evidence: 3.MedicineArticleSCOPUS10.1002/lary.706872-s2.0-10504187327515314995