Problem: One of the largest debates in the reconstruction of the cleft palate is obtaining a balance between efficient velopharyngeal function, maxillofacial growth and appropriate speech. Among these is the debate of whether velopharyngeal insufficiency leads to otitis media, and attributes to subsequent speech problems. Methods: Using WCMC library database, multiple peer-reviewed articles published since 1992 were evaluated. These articles primarily demonstrated the relationships between otitis media and speech. The articles also compared the outcomes of three popular cleft palate reconstructive procedures. Results: This research and evaluation demonstrates that children with reconstructed cleft palate are much more likely to develop velopharyngeal insufficiency leading to otitis media. Additionally, it shows that there is in fact a correlation between the development of otitis media, hearing problems and speech difficulties. Lastly, this research establishes an argument that the Furlow method of palatoplasty has the best outcome in terms of the development of adequate velopharyngeal function, in addition to minimal wound complications. It also examines a recent technique to involve in an established method of palatoplasty; a tensor tenopexy. Conclusions: Children who undergo palatoplasties typically do so at an age that is critical for their speech development. With the complication of otitis media impacting this milestone, it is important to determine the procedure with the best velopharyngeal outcome for these patients.