Septal Deviation of 5-6mm and Nasal Septal Spur: Severe Enough to Need Septoplasty?

To better answer your question a thorough intranasal exam including a fiberoptic scope and a review of your actual sinus cat scan is necessary

Great question. A septoplasty is largely an elective procedure, thus its not really proper to suggest that anyone "needs" or must have a septoplasty. That being said, if you do not breathe well through your nose and there is some discernible obstruction of the nose by your septum then surgery is an excellent option for most patients. Simply put, if you want to breathe better through your nose, and you have a deviated septum, in my opinion there is no single treatment that will improve your breathing more than a well done septal surgery. Septopalsty is exceedingly well tolerated due to little or no pain, and nearly universally successful in improving breathing. Hope this helps. 

 The most important element of this larger picture is the overall story of persistent nasal problems despite medical treatment.  Essentially, if conservative medical treatment could resolve the problem then we wouldn't even need to discuss the septal spur findings on the CT scan.  When conservative management fails, then surgery is indicated and very commonly successful in alleviating much of the symptoms.  When surgery is deemed necessary, the septal spur and less than straight septum should be addressed.  Straightening the septum via resolving the septal spur is needed, but in of itself will not completely resolve the problem.  Nonetheless it should be addressed.On the other hand, one should not have surgery simply because a CT scan indicates that the septum has spurring.  The clinical picture has to be taken into account.

A moderate to severe septal deviation documented on a CAT scan along with a history of symptoms that are unrelieved with medications is usually an indication for surgical intervention.  It is important to try medications first and make sure that they are not working prior to undergoing surgical intervention such as a septoplasty.  In addition, it is also important to address turbinates if they are hypertrophic and once lateralized can improve the airflow dynamics through the nose.  Chronic sinus infections are addressed through endoscopic sinus surgery if there are polyps located inside the sinuses.  This can all be done simultaneously.  

In my practice, the indication for septoplast is based on clinical exam and patient history. If allergy is an issue then complete that part of the workup and treat before moving on to an invasive procedure.

Most doctors do not operate on an x-ray report only. You must be seen and evaluated prior to making any decision regarding surgery. The ct was probably ordered because if you expect your insurance to pay the doctor, they require it. Most well trained physicians can look in your nose and see if you need to have your septum fixed.

A septoplasty is required when the septal cartilage or bone is deviated to the point that it obstructs the nasal breathing.  This can't be detrmined by a CT scan but needs to be determined by an examination of each nasal airway.  If you have adequate space between the septum and the inferior turbinate, you don't need a Septoplasty. 

The Septoplasty will not address the list of symptoms that you listed which maybe due to airborne allergies.  You might consider seeing an allergist for testing to rule that out.  Nasal steroid sprays are helpful but don't really take effect until they're used for 4 weeks.