In Reply With regard to the patient group selected, our entire study group1 had cleft palate (with or without cleft lip) operated on by the team in Glasgow, Scotland. We are aware that cleft lip would not have the same otological influence, and therefore none of the patients with cleft lip without cleft palate were included. Furthermore, with regard to patient selection, the article by Ovesen and Blegvad-Andersen2 mentioned by Dr Kuo cannot be used to compare to our study; that study involved only 11-year-old children. Ventilation tube complication rates are markedly reduced after 5 years of age, and the main cohort of patients for whom we aim to improve outcomes are younger. This does not reflect the age range of most patients treated in our practice for otitis media with effusion or acute otitis media.