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The middle ear mechanism is normally adjusted to transmit sound vibrations in either direction. Ordinarily this apparatus is largely occupied in transmitting sound vibrations from without inward. The membrana tympani is set into vibration by impact of vibrations transmitted by the air in the external auditory canal, and the ossicular chain carries the vibrations across the tympanic cavity to the footplate of the stapes, which, with its annular ligament, fills the oval window. The perilymph there receives the impact, and owing to the venting action of the internal drumhead of the round window, this incompressible fluid is enabled to take up the vibrations and distribute them by way of the saccule and cochlea in such a manner as to bring about interaction between the sensory cells of Corti and the tectorial membrane. This stimulation causes these cells to emit nerve impulses which are translated in the sensorium into hearing.
LEWIS ER. VI. INFLUENCE OF ALTITUDE ON THE HEARING AND THE MOTION-SENSING APPARATUS OF THE EAR. JAMA. 1918;71(17):1398–1399. doi:https://doi.org/10.1001/jama.1918.26020430020009e
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