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 child, 0-15 år
Approximately 5 000 tonsil operations are performed annually on children under 16 years old. The number of operations dropped significantly during the pandemic and only returned to pre-COVID-19 levels in 2023. There is significant geographical variation in the number of operations. Boys are operated on more frequently than girls, and the average age at the time of surgery is slightly lower for boys than for girls.
The proportion of partial tonsil removals (tonsillotomies) has increased from just under 10 % in 2015 to over 40 % after the pandemic. According to the Tonsil Register, one reason for this is that the indication for hypertrophy is used more often for children, and tonsillotomy is considered a safer procedure with fewer postoperative complications.
Children are mainly treated in their own health trust. The significant observed geographical variation over time may indicate overtreatment in some areas and undertreatment in others. However, data from the Tonsil Register for 2023 shows that 92 % were symptom-free 6 months after surgery. 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.
Number of tonsil operations per 1 000 inhabitants, 16 years and older
Approximately 5 000 tonsil operations are performed annually on patients aged 16 and older. The number of operations per year was increasing in the period before the pandemic, peaking in 2019 with nearly 6 000 operations. In 2023, 5 000 operations were performed.
There is significant geographical variation in operation rates, with the areas with the highest rates performing about twice as many tonsil operations per 1 000 inhabitants compared to the areas with the lowest rates.
Women are operated on more frequently than men, and the average age at the time of surgery is about two years lower for women (26 years in 2023) than for men (28 years in 2023). The average age has decreased over the period for both men and women. 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.
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.
