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Both the external ear and the tympanic membranecan be assessed by direct inspection and by using an otoscope.The middle and inner ear cannot be directly inspected. Its mono- and triphosphate deriva-tives generated intracellularly inhibit GTP andviral RNA synthesis and have other sites of actionas well. High levels of ET-l gene expression are associatedwith many diseases that are caused in part by sustained en-dothelium-induced vasoconstriction.