“…In both cases, normal middle ear function and hearing require the clearance of this incompressible fluid and its replacement by compressible air. Several mechanisms have been implicated in this clearance: a pumping action through the eustachian tube following contraction of the tensor veli palatini muscle [Cantekin et al, 1979;Honjo et al, 1981Honjo et al, , 1985; removal by the beating cilia of the mucosal lining (mucociliary mechanism) of the middle ear and eustachian tube [Sade, 1967;Nuutinen et al, 1983]; osmotic outflow of water from the middle ear as a consequence of osmotic pressure gradients between the middle ear fluid and blood [Priner et al, 2003]; active transport of sodium by middle ear epithelium from the middle ear fluid, driving water absorption [Herman et al, 1992;Yen et al, 1993;Li et al, 2005].…”