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Abstract Objectives The primary objective was to determine the prevalence of complications after tympanostomy tube insertion among patients with a cleft palate. The secondary objective was to assess whether patients registered to noninsured health benefits (NIHBs) (all of whom are Indigenous) experience different risk of these complications than patients not registered to NIHB. Methods This retrospective cohort study included paediatric patients (<18 years) treated at a tertiary otolaryngology referral centre serving a large population of Indigenous Peoples, including a subset registered to the NIHB. Patients with cleft palate who underwent tympanostomy tube insertion and had at least 12 months of follow-up with pre- and postoperative audiograms were included. Primary outcomes were the prevalence of tube-related complications and the rate of repeat tympanostomy tube insertions. Results A total of 278 patients met inclusion criteria. The median age at tube insertion was 12 months. Of these, 141 (51%) were male, and 30 (11%) were registered to NIHB. The complication rate was 21% (n = 59), with refractory otorrhea being the most common complication (n = 50, 18%). Repeat tympanostomy tubes were required in 116 patients (42%), and 33 patients (12%) required more than 2 sets of tubes. Patients registered to NIHB were significantly more likely to experience complications and have persistent hearing loss on postoperative audiogram but were not more likely to receive repeat tympanostomy tubes. Conclusion Patients registered to NIHB were disproportionately affected compared with patients not registered to NIHB, and despite being at higher risk for complications, they were not more likely to have repeat procedures.