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