A tympanostomy tube applicator has a hand-held housing (2) and a stem (14) extending from the housing and having a shape arranged for engagement in the ear canal. A tympanostomy tube inserter (50) has a user actuator (10), a rod (56) having a tip (52, 122) to pierce a patient's tympanic membrane and to support a tympanostomy tube (60, 203) through the membrane where it is pierced. The inserter inserts a collapsed tympanostomy tube (60, 203) through the membrane and expands the tube in situ to provide a distal flange (63, 203(c)) in the tympanostomy tube. A myrongotomy tip (50) expands the tube to a final state having a distal flange (63) as it is retracted.
