Here you will find analyses of geographical variation in the use of healthcare services related to the ear, nose and throat. The analyses are selected updates from the Child Healthcare Atlas and the Day Surgery Atlases (1 and 2).
Number of tonsil operations per 1,000 children, 0–15 years
In 2024, a total of 5,200 tonsil operations were performed on children under the age of 16. The number of procedures dropped significantly during the pandemic. In 2023, the number exceeded pre-COVID-19 levels by a clear margin and rose slightly further in 2024. The number of operations per 1,000 inhabitants was highest in Finnmark in 2024, with a rate of just over 10. In other catchment areas, the rates ranged between 3.5 and 7. The average age of boys undergoing surgery is slightly lower than that of girls.
The proportion of patients receiving partial removal of the tonsils (tonsillotomy) has increased from just under 10% in 2015 to over 40% following the pandemic. According to the Tonsil Register, one reason for this is that the indication "hypertrophy" is more frequently used in children, for whom tonsillotomy is considered a safer procedure with fewer postoperative complications.
In 2024, 13% of children were treated by private providers. This proportion varies between catchment areas. UNN and St. Olav have the highest shares, at 49% and 30% respectively, while no children in the catchment areas of Førde, Fonna, or Telemark underwent surgery with private providers.
The reduction in the rate for the Bergen catchment area from 2022 to 2023 is likely due to a lack of reporting from contracted specialists in 2023.
The analysis is based on data from the Norwegian Patient Registry (NPR) for specialist healthcare services. The data includes activity in public hospitals, publicly funded private hospitals, and specialists in private practice under public funding contacts.
The sample consists of patients aged 0-15 years registered with a primary or secondary diagnosis of J35.0, J35.1, J35.3, J35.8, J35.9, J36, J39.0, J03.0, J03.8, J03.9, or G47.3 in combination with:
Tonsil operations with only the procedure codes EMB12 or EMB15 and at the same time none of the other procedure codes or fee codes are defined as tonsillotomy. All other tonsil operations are defined as tonsillectomy. Tonsillotomies are also performed by specialists, but since the fee codes K02f and K02g are tonsillectomy/tonsillotomy, it is not possible to distinguish between tonsillectomy and tonsillotomy using the fee codes. K02a and K02e are tonsillectomy.
The place of treatment is divided into three categories:
In order to compare the catchment areas and between years, the rates have been adjusted for gender and age. The adjustment was done using the direct method with the population in 2023 as the reference population.
SKDE is solely responsible for the interpretation and presentation of the data provided by NPR. FHI/NPR is not responsible for analyses or interpretations based on the data.
Number of tonsil operations per 1,000 inhabitants, 16 years and older
In 2024, nearly 5,600 tonsil surgeries were performed on patients aged 16 and over. The number of operations per year had been increasing in the period before the pandemic, peaking in 2019 with almost 6,000 procedures. The lowest numbers were recorded in 2021 and 2022, with just under 4,600 operations. In 2024, the figure has returned to pre-pandemic levels.
There is considerable geographical variation in surgery rates. The catchment areas with the highest rates perform around twice as many tonsil surgeries per 1,000 inhabitants compared with those with the lowest rates. In 2024, the rate ranged from 0.88 operations per 1,000 inhabitants in Telemark to 1.95 in the UNN catchment area.
64% of the surgeries are performed on women. In 2024, the average age of female patients is around two years lower (just under 26 years) than that of male patients (28 years).
The analysis includes tonsillectomy and tonsillotomy procedures. The number of tonsillotomy operations is low, comprising just under 150 procedures in 2024. Nearly 40% of these were for patients in the Østfold catchment area.
The analysis is based on data from the Norwegian Patient Registry (NPR) for specialist healthcare services. The data includes activity in public hospitals, publicly funded private hospitals, and specialists in private practice under public funding contacts.
The sample consists of patients aged 16 years or older registered with a primary or secondary diagnosis of J35.0, J35.1, J35.3, J35.8, J35.9, J36, J39.0, J03.0, J03.8, J03.9, or G47.3 in combination with:
The place of treatment is divided into three categories:
In order to compare the catchment areas and between years, the rates have been adjusted for gender and age. The adjustment was done using the direct method with the population in 2023 as the reference population.
SKDE is solely responsible for the interpretation and presentation of the data provided by NPR. FHI/NPR is not responsible for analyses or interpretations based on the data.
Number of procedures with ventilation tubes in the eardrum per 1,000 children, 0–16 years
Approximately 5,000 procedures involving the insertion of ventilation tubes in the eardrum are performed annually on children aged 0-16 years. The number of procedures decreased from 2015 to 2019, and there was a significant drop during the pandemic. In 2023, the number of procedures returned to the 2019 level.
There is significant geographical variation in the number of procedures. The catchment area for Nord-Trøndelag HF consistently has the highest rate throughout the period, while the catchment areas in Oslo (OUS, Lovisenberg, and Diakonhjemmet HF) consistently have low rates. The procedure is performed more than three times as frequently on children in the catchment area for Nord-Trøndelag HF compared to the Oslo area in all years of the period. This suggests that there is a lack of consensus among medical experts regarding the appropriate indications for using ventilation tubes. The medical need is assumed to be approximately the same regardless of where in Norway one lives, and the variation therefore is considered as unwarranted.
The procedure is performed more frequently on boys than girls, with 60% of the procedures performed on boys. The average age at the time of the procedure was five years, and the procedure is most commonly performed on three-year-olds.
Children are mainly treated in their own HF, but there are significant differences between catchment areas. In 2023, 75% of the procedures were performed in their own HF, 8% in another HF, and 16% were performed privately for the country as a whole. In the catchment areas for St. Olav and Diakonhjemmet HF, more than half of the procedures in 2023 were performed privately.
The analysis is based on data from the Norwegian Patient Registry (NPR) for specialist healthcare services. The data includes activity in public hospitals, publicly funded private hospitals, and specialists in private practice under public funding contacts.
The sample consists of all contacts (admissions, outpatient consultations, and day treatments) involving the insertion of ear tubes for children in somatic specialist health services, including private contract specialists. The insertion of ear tubes is defined by the procedure code (NCSP) DCA20 for DRG-financed hospitals, and the tariffs K02c, K02d, K02e, or K02g for private contract specialists. The tariff 317b (Paracentesis with ventilation tube) for contract specialists is not included as this procedure is mainly performed on adults.
The place of treatment is divided into three categories:
In order to compare the catchment areas and between years, the rates have been adjusted for gender and age. The adjustment was done using the direct method with the population in 2023 as the reference population.
SKDE is solely responsible for the interpretation and presentation of the data provided by NPR. FHI/NPR is not responsible for analyses or interpretations based on the data.
