In chronic suppurative otitis media with cholesteatoma, which structure is primarily damaged?

In chronic suppurative otitis media with cholesteatoma, the primary structure that is damaged is the pars flaccida. This area of the tympanic membrane is located superiorly and is more susceptible to retraction and perforation due to the chronic inflammatory process associated with cholesteatoma. The presence of cholesteatoma occurs when skin cells and other debris collect in the middle ear, often leading to the erosion of the surrounding structures.

Damage to the pars flaccida can create a retraction pocket where the skin can invade the middle ear space and cause further complications, including destruction of the ossicular chain, particularly affecting the incus and malleus, but it begins with the damage in this particular area of the tympanic membrane.

The pars tensa, while also a component of the tympanic membrane, is less affected in the early stages of cholesteatoma due to its greater structural integrity. The stapes and the round window are more associated with hearing loss and the transmission of sound rather than being the target of damaging processes in this specific condition. Thus, focusing on the pars flaccida in chronic suppurative otitis media with cholesteatoma is critical to understanding the pathophysiology