For several years I've been using a nasal steroid on a daily basis.
Prior to that I used an over the counter nasal decongestant.  About
two years ago, I developed a perforated septum (likely caused by the
otc decongestant spray).

My ENT at the time suggested keeping a close watch on the perforated
condition but allowed me to continue the nasal steroid.  I
subsequently relocated to another city and my primary care physcian
referred me to a new ENT.

On my initial visit he directed me to stop using the nasal steroid and
indicated I would need to have surgery on the perforated septum and
possibly some sinus work.  The next visit, after a CT scan, he
strongly advocated surgery not only to fix the perforated septum but
also to fix a slight deviation problem and a "possible" polyup.

I was quite taken a back since my former ENT always preferred
alternative treatment with surgery only a last resort.  I have also
been examined by an allergist MD and learned that many of my sinus
symptoms are related to allergens.  With daily irrigation (using
pulsating device) and Astelin nasal spray, my condition has improved
significantly

Question is whether or not the septum condition needs an operation?  I
have some minor crusting but with the use of a gel seems not to be a
problem.  No wheezing from the perforation.