3-28 U.S. Navy Diving Manual — Volume 1 transmits sound vibrations to the incus, which in turn transmits these vibrations to the stapes, which relays them to the inner ear. The stapes transmits these vibrations to the inner ear fluid through a membrane-covered hole called the oval window. Another membrane ­ covered hole called the round window connects the inner ear with the middle ear and relieves pressure waves in the inner ear caused by move ment of the stapes. When the stapes drives the oval window inward, the round window bulges outward to compensate. The fluid-filled spaces of the inner ear are also connected to the fluid spaces surrounding the brain by a narrow passage called the cochlear aqueduct. The cochlear aqueduct can transmit increases in cerebrospinal fluid pressure to the inner ear. When Valsalva maneuvers are performed to equalize middle ear and sinus pressure, cerebrospinal fluid pressure increases. If middle ear pressure is not equalized during descent, the inward bulge of the eardrum is transmitted to the oval window by the middle ear bones. The stapes pushes the oval window inward. Because the inner ear fluids are incompressible, the round window correspondingly bulges outward into the middle ear space. If this condition continues, the round window may rupture spilling inner ear fluids into the middle ear and leading to a condition know as inner ear barotrauma with perilymph fistula . Fistula is a medical term for a hole in a membrane; the fluid in the inner ear is called perilymph. Rupture of the oval or round windows may also occur when middle ear pressures are suddenly and forcibly equalized. When equalization is sudden and forceful, the eardrum moves rapidly from a position of bulging inward maximally to bulging outward maximally. The positions of the oval and round windows are suddenly reversed. Inner ear pressure is also increased by transmission of the Valsalva-induced increase in cerebrospinal fluid pressure. This puts additional stresses on these two membranes. Either the round or oval window may rupture. Rupture of the round window is by far the most common. The oval Tympanic Membrane Tensor tympani Malleus Incus Stapedius Muscle Stapes Oval Window Eustachian Tube Figure 3-9. Components of the Middle Ear.

The PDF viewer opens on the cited page and searches this passage for highlight.