D. The consumption of legal and illegal drugs
Effective communication is obviously influenced by different fators among which we can surely include acceptance of responsibility. You have to consider that when someone is taking responsibility for his actions this will make the person who he's talking to view him more favourably, as a more responsible person and perhaps even as someone who wants to sensibely solve problems.
Answer: Cholesteatoma
Explanation:
A cholesteatoma is a medical condition in which abnormal non cancerous growth that can develop in the middle section of the ear located behind the eardrum.
It can be a birth defect which is mostly caused by the repeated middle ear infection. In this condition cyst forms that sheds the older layer of skin.
Here, the condition that is seen is Cholesteatoma.