Black N
J R Soc Med. 1985 Aug;78(8):641-8. doi: 10.1177/014107688507800809.
Study of geographical variations in the rate of surgery for glue ear reveals striking differences both between English health regions and between health districts. There are two-fold differences between regions and up to seven-fold differences between districts. Analysis of these differences at different levels of population aggregation reveals that professional uncertainty about the indications and value of surgery for this condition is the major factor responsible. In addition, the availability of otolaryngologists influences the surgical rate at district though not at regional level. The method used in this study is unable to determine the part played by geographical variation in patient expectation and morbidity rate. In contrast to the lack of consensus among otolaryngologists regarding the use of surgery for glue ear, there appears to be a high degree of agreement as regards tonsillectomy. The latter has coincided with the end of the decline in the tonsillectomy rate in the late 1970s.
关于分泌性中耳炎手术率的地理差异研究显示，在英国各健康区域之间以及各健康区之间存在显著差异。区域之间存在两倍的差异，而区与区之间差异高达七倍。在不同人口聚集水平上对这些差异进行分析后发现，对于这种病症手术适应症和价值的专业不确定性是主要原因。此外，耳鼻喉科医生的可及性会影响区级的手术率，但对区域层面无影响。本研究中使用的方法无法确定地理差异在患者期望和发病率中所起的作用。与耳鼻喉科医生在分泌性中耳炎手术使用方面缺乏共识形成对比的是，扁桃体切除术方面似乎存在高度一致性。这与20世纪70年代末扁桃体切除率下降趋势的结束相吻合。
