Earplug

An earplug is a device that is inserted in the ear canal

to protect the user's ears from loud noises, intrusion of
water, foreign bodies, dust or excessive wind.
Earplugs may be used as well to improve sleep
quality or focus in noisy environments. Since they
reduce the sound volume, earplugs may prevent
hearing loss and tinnitus (ringing of the ears), in some
cases.[1][2]

US Occupational Safety and Health Administration

Pre-molded earplugs (left), formable earplugs
requires hearing conservation programs which include (center), and roll-down foam earplugs (right)
the provision of hearing protection devices (HPDs).
But this does not mean that OSHA considers HPDs to
be effective.[3]

History
The first recorded mention of the use of earplugs is in the Greek tale Odyssey, wherein Odysseus's crew is
warned about the Sirens that sing from an island they will sail past. Circe, their hostess, tells them of the
Sirens' bewitching song that makes men drive their boats ashore and perish. She advised Odysseus to
fashion earplugs for his men from beeswax so they would not be lured to their deaths by the sirens' song.

In 1907, the German company Ohropax, which would produce mainly wax earplugs, was started by the
German inventor Max Negwer. Ray and Cecilia Benner invented the first moldable pure silicone ear plug
in 1962. These earplugs were valued by swimmers because of their waterproof qualities, as well as those
trying to avoid harmful noise. Ray Benner, who was a Classical musician, bought McKeon Products in
1962. At that time, the company's sole product was Mack's Earplugs (named after the original owner),
which was a moldable clay earplug. The Benners quickly redesigned the product to a silicone version,
which would become known as Mack's Pillow Soft Earplugs.

Present-day earplug material was discovered in 1967, at National Research Corporation (NRC) in the US
by Ross Gardner Jr. and his team. As part of a project on sealing joints, they developed a resin with
energy absorption properties. They came to call this material "E-A-R" (Energy Absorption Resin). In
1972 the material was refined into commercial memory foam earplugs, made from either polyvinyl
chloride or polyurethane.

Hearing protection
There are mainly four types of earplug fittings for hearing protection:
 Foam earplugs, mainly made from either polyvinyl
chloride (PVC) or polyurethane (PU) (memory foam),
which are compressed (rolled) and put into the ear
canal, where they expand to plug it.
Wax earplugs, which are rolled into a ball and carefully
Badly-inserted earplug, semi-
molded to fit over the external portion of the ear canal.
inserted earplug, and properly-
Flanged silicone earplugs, an example of Universal-fit. inserted earplug
Custom molded earplugs, made from a mold of the
wearer's ear and designed to precisely fit all ear canal
shapes. Custom molded is further divided into laboratory-made and "formed in place".
NIOSH Mining Safety and Health Research recommends using the roll, pull, and hold method when
using memory foam earplugs.[4] The process involves the user rolling the earplug into a thin rod, pulling
back on the ear, and holding the earplug deep in the ear canal with the finger.[4] To get a complete seal,
the user must wait about 20 to 30 seconds for the earplug to expand inside the canal.[5]

Earplugs are most effective when the wearer has been properly trained on use and insertion. Employers
can provide this training before dispensing earplugs to their employees. Training for earplug use includes:
insertion, a seal check, depth check, removal, cleaning, and replacement. When training on insertion, the
objective is for the worker to understand the correct insertion strategy. Proper insertion training prevents
inadequate insertion, that can result in discomfort or inadequate attenuation, which can result in hearing
loss. When this step is achieved, then the seal and depth need to be checked. The ear plugs all have a
desired depth and seal which need to be achieved to provide the designated attenuation for the wearer.
The worker will also be trained on how to properly remove the earplugs and clean them. This allows for
multiple uses and reduces the chance of infection. To further prevent infection, it is important the worker
understands when they will need to replace their earplugs. Once the plugs have been worn down from
repeated use, they will no longer seal correctly or provide the proper attenuation level, and the device will
need to be replaced.[6]

Noise attenuation can be verified using real-ear attenuation

at threshold (REAT) or microphone in the real ear (MIRE)
methods.[7] The difference in thresholds with and without
the hearing protection in place determines the amount of
attenuation (REAT).[8] Two microphones measure the sound
pressure (of test signals, or noise in the workplace during a
shift) outside the HPD and inside, and the difference shows
the noise attenuation (MIRE).

Earplugs and other hearing protection devices can be tested

to ensure that they fit properly and are successfully limiting Earplugs with probe for MIRE
measurements of noise exposure on the
sound exposure, which is called fit-testing. There are a
worker's eardrums
number of different fit-testing systems, also known as field
attenuation estimation systems (FAES). These use large
headphones or specialized (surrogate) earplugs to transmit the test sounds and measure the attenuation
provided by the hearing protector. These systems include the NIOSH HPD Well-Fit, Honeywell Howard
Leight VeriPRO, 3MEARFit and many others.[7]
 Time reaching maximum daily dose, hours : minutes

ISO 1999,[11] Netherlands,[12]

OSHA,[9] NIOSH,[10]
RF[13]
Noise, TWA 90 dB(A), TWA 85 dB(A),
dBA TWA 80 dB(A),
exchange rate 5 dB exchange rate 3 dB
exchange rate 3 dB

80 - - 8 : 00

81 - 20 : 9.5 6 : 21
82 - 16 : 00 6 : 02

83 21 : 07 12 : 42 4 : 00

84 18 : 23 10 : 4.8 3 : 10
85 16 : 00 8 : 00 2 : 31

86 13 : 56 6 : 21 2 : 00

87 12 : 08 5 : 2.4 1 : 35
88 10 : 33 4 : 00 1 : 16

89 9 : 11 3 : 10 1 : 00

90 8 : 00 2 : 31 48 min
91 6 : 58 2 : 00 38 m

92 6 : 04 1 : 35 30 m

93 5 : 17 1 : 16 24 m
94 4 : 36 1 : 00 19 m

95 4 : 00 0 : 48 15 m

96 3 : 29 0 : 38 12 m
97 3 : 02 0 : 30 9.4 m

98 2 : 38 0 : 24 7.5 m

99 2 : 18 0 : 19 6m
100 2 : 00 0 : 15 4 m 43 sec

101 1 : 44 0 : 12 3 m 45 s

102 1 : 31 9 min 24 sec 2 m 58 s

103 1 : 19 7 m 30 s 2 m 22 s

104 1 : 09 6m 1 m 53 s

105 1 : 00 4 m 42 s 1 m 29 s
106 52 m 3 m 48 s 1 m 11 s

107 45 m 3m 56 s

108 40 m 2 m 24 s 45 s
109 34 m 1 m 54 s 36 s

110 30 m 1 m 30 s 28 s
 Permissible noise levels in different countries[12]
Level increase corresponding to doubling
TWA, dBA
the dose
Country (for an 8-hour shift) (Exchange rate)

Argentina 90 3

Australia 85 3

Brazil 85 5

Canada 85 & 82[14] 3

Chile 85 5

China 70-90 3

European Union
85 3
countries
Finland 85 3

France 85 3

Germany 85, 70, 55[15] 3

Hungary 85 3

India 90 -
Israel 85 5

Italy 85 3
Netherlands 80 3

New Zealand 85 3

Norway 85, 55, 70 3

RF[13] 80 3

Spain 85 3
Sweden 85 3

United Kingdom 85 3

USA 90 (100)* 5
Uruguay 90 3

OSHA issued a directive to the Compliance Safety and Health Officers in 1983.[16] They are ordered to stop
requiring employers to install engineering noise control if noise dose < 100 dBA. This decision is considered
illegal,[17] but it is carried out in practice in most US states.[18]
These numerical values do not fully reflect the real situation. For example, the OSHA
standard[9] sets the Action Level 85 dBA, and the PEL 90 dBA. But in practice, the
Compliance Safety and Health Officer must record the excess of these values with a margin,
in order to take into account the potential measurement error. And, in fact, instead of PEL 90
dBA, it turns out 92 dBA, and instead of AL 85 dBA - 87 dBA.[19]
Types and use cases
The diameter of the ear canals can be from 3 to 14 mm. They can be round, elliptical, and even slit-like.
The ear canals may be straight, but more often curved to varying degrees. The shape and size of the right
and left ear canals for the same worker can vary significantly.[20] Installing the earplugs neatly and
tightly (without gaps) can be a difficult task.

Since the fitting of the earplugs greatly affects their noise attenuation,[7] various designs of these personal
protective equipment have been developed.

Simple earplugs
Basic foam style earplug protection is often worn by industrial
workers who work within hearing distance of loud machinery for
long periods of time, and is used by the British Ministry of
Defence (MoD) for soldiers to use when firing weapons. Earplugs
are rated for their ability to reduce noise; see § Rating.

Most disposable earplugs

are elastic ones made of
memory foam, that is
typically rolled into a
tightly compressed cylinder
(without creases) by the
user's fingers and then
inserted in the ear canal.
Once released, the earplug
expands until it seals the
canal, blocking the sound
Earplugs with instructions for use
vibrations that could reach
the eardrum. Other
disposable plugs simply
push into the ear canal
without being rolled first.
Sometimes earplugs are
connected with a cord to
Disposable foam earplugs: with keep them together when
coins for scale (top) and inserted not in use. Other common
into the wearer's ear.
material bases for
Flanged earplugs made from
disposable earplugs are silicone rubber. The hole in the left
viscous wax or silicone. plug is the input port and extends as
far as the central flange where the
Other devices that provide hearing protection include electronic attenuation occurs
devices worn around and/or in the ear, and are designed to cancel
out the loud noise of a gunshot, while possibly amplifying quieter
sounds to normal levels. While rich in features, these electronic devices are more expensive, compared to
their foam counterparts.

In other activities, hobby motorcyclists and skiers may also choose to use decibel reduction earplugs, to
compensate for the ongoing noise of the wind against their head or helmet.

Musicians' earplugs
Musicians are exposed to potentially harmful levels of sound,
which can lead to hearing loss, tinnitus, and other auditory
symptoms. Because of this, musicians may choose to use earplugs.

Musician's earplugs (also called Hi-Fi or Lossless earplugs) are

designed to attenuate sounds evenly across all frequencies
(pitches) which helps maintain the ear's natural frequency
response and thus minimizes the effect on the user's perception of
timbre (frequency spectrum, [Link]. bass and treble levels). These Musicians' earplugs. The grey end
are commonly used by musicians and technicians, both in the caps contain an acoustic
studio and in concert, to avoid overexposure to high volume transmission line with a damper
levels. Musician's earplugs generally achieve a more natural (attenuator) at the end while the
frequency response by incorporating a small diaphragm or domed flanges form a seal in the
membrane together with acoustic channels and damping ear canal. The output port can just
be seen as a small hole at the near
materials.[21] Simpler variants with only a small hole introduce a
end of the left plug
low frequency leak, and will not achieve a flat frequency response.
Examples of manufacturers of membrane-based earplugs are ACS,
Etymotic and Minuendo.

Preformed earplugs, such as the ER-20 earplug are universal (non-custom) earplugs with a noise
reduction rating (NRR) of about 12 dB. A selection of musician's earplugs have been reviewed by the
National Acoustic Laboratories and The HEARing CRC in conjunction with Choice.[22][23] The review
results (which include attenuation measures and user ratings of comfort, fit and sound quality) are
available at What Plug?.[24]

A more expensive option is the custom molded musician's earplug, which is custom-made for the
individual listener. These earplugs are typically made out of silicone or vinyl materials and come with a
vent and a variety of filters that can change the amount of attenuation provided. Common static filter
attenuation levels are 9, 15, and 25 dB.[25] This type of plug is quite popular among audio engineers who
can safely listen to loud mixes for extended periods of time. However, they can be quite costly, being
intended for constant re-use unlike simple earplugs which are disposable.

Alternately, musicians may use in-ear monitors, which are essentially headphones that also serve as
earplugs by attenuating surrounding sound. In order for in-ear monitors to double up as hearing
protection, custom earpieces should be used. The process for having custom earpieces made is similar to
that of the custom musician's earplug and, similarly, the earpiece will be made of silicone or vinyl. While
using an in-ear monitor can help protect hearing, the amount of protection provided by the monitor
depends on the listening level that the musician chooses. Because of this, if the musician sets the monitor
to a high level, the monitor may attenuate surrounding sound while still providing a potentially harmful
level of sound directly to the musician's ear and therefore no longer serve a protective function.[25]
Several earplugs on the market claim to be for musicians, but are
not in fact by definition a musician's earplug. By having a thin
acoustical bypass channel, they allow for a slightly better
frequency response and lower attenuation than simple earplugs,
but far from the level of fidelity that membrane-based earplugs
provide. These types of earplugs do not provide the flat
attenuation that is characteristic of a musician's plug, but may still
be useful for some, due to their lower price points.[25]
Custom earplugs worn by
professional musicians
Custom molds
Earplugs can be molded to fit an individual's ear canal. This costs
more, but can improve fit for the few percent that have an ear
anatomy outside the norm.[26]

Custom molded earplugs fall into two categories: Laboratory

made and Formed in Place. Laboratory made requires an
impression to be made by a professional of the ear canal and outer
ear. The impression is sent to a laboratory to be checked and made
into a hearing protector. Formed in place uses the same process to
make an impression of the ear canal and outer ear and then turns
that impression into the protector. Both types of custom molded
earplugs are non-disposable with the laboratory made typically
lasting for 3 – 5 years and the formed in place lasting for 1 – 2
years.

For the best attenuation and proper fit, the impressions for custom
molds must meet a desired criteria by the manufacturer of the
mold. Before an impression can be taken for the custom mold the Lead singer of the metal band
ear canal is checked for any wax or physical abnormalities. This is Sepultura Derrick Green wearing a
important in making sure there is a proper seal with the impression custom earplug
material and also not to push any wax deep into the canal. The
otoblock (made with foam or cotton) will be inserted deep in the
canal to prevent the impression material from going too far. The impression material (either silicone or
powder/liquid) will be placed into the ear canal. This will need to be fully made, making sure there are no
gaps or creases in the impression. If there are, then the mold made from the impression will not
adequately seal the ear canal. Once the custom mold is made, it will need to be inspected by the
Audiologist for proper fit on the patient. Hearing protection should also be verified using real-ear
methods to ensure proper attenuation. Real-ear attentuation at threshold (REAT) measurements test how
narrowband noises of varying frequency are attenuated with and without the custom mold in place.
Testing for low-frequency attenuation can help to verify the earmold fit while testing high-frequency
attenuation can verify the properties of the filter used.[6][21]

For best results they are molded in the ear while in the position that they will be used. For instance, if
they are to be used for sleeping then they should be molded in the ear while lying down, as different
positioning of the jaws causes significant changes to the form of the ear canal, mostly a reduction of the
diameter, risking the sleep earplug to be made too large otherwise. It is also important that during the
impression process that a music performer use their embouchure or move the jaw to mimic singing in
order to account for ear canal changes during performance. Therefore, if the impression is not properly
constructed, then it will need to be redone.[21] These changes can be felt by feeling with a finger just at
the entrance to the ear canal while moving the jaws sideways, up and down or anterior and posterior.

Most molded earplugs are made from silicone but other materials may be used, including
thermoplastics,[27] plastic, nylon [28] and even 3-D printed earplugs.

Electronic earplugs
The noise reduction of passive earplugs varies with frequency but is largely independent of level (soft
noises are reduced as much as loud noises). As a result, while loud noises are reduced in level, protecting
hearing, it can be difficult to hear low level noises. Active electronic earplugs exist, where loud noises are
reduced more than soft noises, and soft sounds may even be amplified, providing dynamic range
compression. This is done by having a standard passive earplug, together with a microphone/speaker pair
(microphone on outside, speaker on inside; formally a pair of transducers), so sound can be transmitted
without being attenuated by the earplug. When external sounds exceed an established threshold (typically
82 dBA SPL), the amplification of the electronic circuit is reduced. At very high levels, the amplification
is turned off automatically and you receive the full attenuation of the earplug just as if it were turned off
and seated in the ear canal. This protects hearing, but allows one to hear normally when sounds are in
safe ranges – for example, have a normal conversation in a low-noise situation, but be protected from
sudden loud noises, for example at a construction site or a while hunting.

Nonlinear earplugs
Nonlinear earplugs provide similar advantages to electronic earplugs but do not require electricity. They
are designed with a thin diaphragm which allows the amount of noise reduction to increase in proportion
to the sound level to which the wearer is exposed.[29] This makes them useful for applications where
situational awareness is required but noise protection is also necessary, such as the military or police.

Sleep
Earplugs for sleeping are made to be as comfortable as possible while blocking external sounds that may
prevent or disrupt sleep. Specialized earplugs for such noises as a partner's snoring may have sound-
dampening enhancements that enable the user to still hear other noises, such as an alarm clock.[30]

To determine the comfort of earplugs used for sleeping, it is important to try them on while actually lying
down. The pressure on the ear between the head and pillow may cause significant discomfort.
Furthermore, just tilting the head back or to the side causes significant anatomical changes in the ear
canal, mostly a reduction of the ear canal diameter, which may reduce comfort if the earplug is too large.
Earplugs for sleeping may enhance recovery after major surgery. [31]

Protection from water

Some earplugs are primarily designed to keep water out of the ear canal, especially during swimming and
water sports. This type of earplug may be made of wax or moldable silicone which is custom-fitted to the
ear canal by the wearer.
Exostosis, or surfer's ear, is a condition which affects people who spend large amounts of time in water in
cold climates. In addition, wind may increase the prevalence of the amount of exostosis seen in one ear
versus the other dependent on the direction it originates from and the orientation of the individual to the
wind.[32] Custom-fitted surfer's earplugs help reduce the amount of cold water and wind that is allowed to
enter the external ear canal and, thus, help slow the progression of exostosis.

Another condition is otitis externa, which is an infection of the outer ear canal. This form of infection
differs from those commonly occurring in children behind the eardrum, which is otitis media, or a middle
ear infection. This infection's symptoms include: itchiness, redness, swelling, pain upon tugging of the
pinna, or drainage. To protect from this form of infection, it is important to thoroughly dry the ears after
exposing them to water with a towel. To protect the ears during exposure, the individual can use a head
cap, ear plugs, or custom-fitted swim molds.[33]

A 2003 study published in Clinical Otolaryngology found that a cotton ball saturated with petroleum jelly
was more effective at keeping water out of the ear, was easier to use, and was more comfortable than wax
plugs, foam plugs, EarGuard, or Aquafit.[34]

Jacques-Yves Cousteau[35] warned that earplugs are harmful to divers, especially scuba divers. Scuba
divers breathe compressed air or other gas mixtures at a pressure matching the water pressure. This
pressure is also inside the ear, but not between the eardrum and the earplug, so the pressure behind the
eardrum will often burst the eardrum. Skin divers have less pressure inside the ears, but they also have
only atmospheric pressure in the outer ear canal. The PADI (Professional Association of Diving
Instructors) advises in the "Open Water Diver Manual" that only vented earplugs designed for diving
should be used in diving.

Flight ear protection

Earplugs are also available which help to protect ears from the pain caused by airplane cabin pressure
changes. Some products contain a porous ceramic insert which reportedly aids equalization of air
pressure between the middle and outer ear thereby preventing pain during landings and take-offs. Some
airlines distribute regular foam earplugs as part of their amenity kits for passengers to aid their comfort
during landings and takeoffs as well as to reduce exposure to the aircraft's noise during the flight. These
can help passengers get to sleep during the flight if desired.

Noise attenuation, labeled (NRR, SNR, HML, SLC80) and real-

world
In the past, experts believed that HPDs noise attenuation in laboratories and workplaces were similar.
Therefore, they developed different methods for predicting noise attenuation at the workplaces using lab
data. Later, derating methods were developed. Many of these methods have been preserved in various
regulatory documents and older standards.

Unfortunately, all these methods and derating do not take into account at all and are not able to take into
account the strong individual variability in noise attenuation in principle, for example, plus or minus 20
decibels.[36][2]
New standards have been developed that
better correspond to the current level of
science.[38][39]

Rating
The United States Environmental Protection
Agency (EPA) mandates that hearing
protection is rated and labeled. To be rated,
hearing protection is tested under ANSI
S3.19-1974 to provide a range of attenuation
values at each frequency that can then be
used to calculate a Noise Reduction Rating
(NRR). Under this standard a panel of ten
subjects are tested three times each in a
laboratory to determine the attenuation over
a range of 9 frequencies.

In the European Union, hearing protectors

are required to be tested according to the Noise attenuation, earplugs EP100. The difference between
International Organization for laboratory predictions (top) and real-world data[37] (bottom)
Standardization (ISO) acoustical testing
standard, ISO 4869 Part 1 and the Single
Number Rating (SNR) or High/Middle/Low (HML) ratings are calculated according to ISO 4869 Part 2.
In Brazil, hearing protectors are tested according to the American National Standards Institute ANSI
S12.6-1997 and are rated using the Noise Reduction Rating Subject Fit NRR(SF). Australia and New
Zealand have different standards for protector ratings yielding a quantity SLC80 (Sound Level Class for
the 80th percentile). Canada implements a class system for rating the performance of protectors. Gauger
and Berger have reviewed the merits of several different rating methods and developed a rating system
that is the basis of a new American National Standard, ANSI S12.68-2007

The various methods have slightly different interpretations, but each method has a percentile associated
with the rating. That percent of the users should be able to achieve the rated attenuation. For instance, the
NRR is determined by the mean attenuation minus two standard deviations. Thus, it translates to a 98%
statistic. That is, at least 98 percent of users should be able to achieve that level of attenuation. The SNR
and HML are a mean minus one standard deviation statistic. Therefore, approximately 86% of the users
should be able to achieve that level of protection. Similarly, the NRR (SF) is a mean minus one standard
deviation and represents an 86% of users should achieve that level of protection. The difference between
the ratings lies in how the protectors are tested. NRR is tested with an experimenter-fit protocol.
SNR/HML are tested with an experienced subject-fit protocol. NRR (SF) is tested with a naive subject-fit
protocol. According to Murphy, et al. (2004), these three protocols will yield different amounts of
attenuation with the NRR being the greatest and NRR (SF) being the least.

The experimenter-fit NRR should be adjusted per the guidelines of the National Institute for Occupational
Safety and Health as the required NRR ratings differ greatly from lab tests to field tests.
The NRR(SF) used in Brazil, Australia, and New Zealand does not require derating as it resembles the
manner in which the typical user will wear hearing protection.

Noise Reduction Rating (NRR)

Hearing protectors sold in the US are required by the EPA to have a noise reduction rating (NRR),[40]
which is an estimate of noise reduction at the ear when protectors are worn properly.

Real-ear attenuation at threshold (REAT) measurements are performed multiple times with 10 to 20
subjects to determine the NRR. Using the collected data, an average group attenuation is reported along
with a standard deviation for attenuation on the hearing protector package.[8]

Due to the discrepancy between how protectors are fit in the testing laboratory and how users wear
protectors in the real world, the Occupational Safety and Health Administration (OSHA) and the National
Institute for Occupational Safety and Health (NIOSH) have developed derating formulas to reduce the
effective NRR.

While the NRR and the SNR (Single Number Rating) are designed to be used with C-weighted noise,
which means that the lower frequencies are not de-emphasized, other ratings (NRR(SF) and NRSA) are
determined for use with A-weighted noise levels, which have lower frequencies de-emphasized. NIOSH
recommended and the U.S. EPA mandated [40] that 7-dB compensation between C and A weighting be
applied when the NRR is used with A-weighted noise levels.

The OSHA training manual for inspectors says the adequacy of hearing protection for use in a hazardous
noise environment should be derated to account for how workers typically wear protection relative to
how manufacturers test the protector's attenuation in the laboratory.[41] For all types of hearing protection,
OSHA's derating factor is 50%. If used with C-weighted noise, the derated NRR will become NRR/2.[41]
If used with A-weighted noise, OSHA applies the 7-dB adjustment for C-A weighting first then derates
the remainder.[41] For example, a protector with 33-dB attenuation would have this derating:

Derated NRR = (33 – 7)/2

NIOSH has proposed a different method for derating based upon the type of protector.[42] For earmuffs,
the NRR should be derated by 25%, for slow-recovery foam earplugs the derating is 50% for all other
protection, the derating is 70%. NIOSH applies the C-A spectral compensation differently than OSHA.
Where OSHA subtracts the 7-dB factor first and derates the result, NIOSH derates the NRR first and then
compensates for the C-A difference. For example, to find the derated NRR for an earmuff by using the
NIOSH derating system, the following equation would be used:

Derated NRR = (Original NRR x (1-.25)) – 7

Painful discomfort occurs at approximately 120 to 125 dB(A),[43] with some references claiming
133 dB(A) for the threshold of pain.[44] Active ear muffs are available with electronic noise cancellation
that can reduce direct path ear canal noise by approximately 17–33 dB, depending on the low, medium, or
high frequency at which attenuation is measured.[45] Passive earplugs vary in their measured attenuation,
ranging from 20 dB to 30 dB, depending on the fit of the earplugs, whether the employee can and knows
how to insert the earplugs into the ear canal correctly, and whether they are used correctly[2][46] and if
low pass mechanical filters are also being used.

Double protection
The Canadian standard requires the use of two passive protective measures simultaneously at noise levels
above 105 dBA. But the noise reduction does not increase very much. It is recommended to estimate the
attenuation by adding 5 dB to the highest attenuation of one of the two HPDs. This recommendation does
not take into account individual differences at all, and may lead to error.[47]

Using both ear muffs (whether passive or active) and earplugs simultaneously results in maximum
protection, but the efficacy of such combined protection relative to preventing permanent ear damage is
inconclusive, with evidence indicating that a combined noise reduction ratio (NRR) of only 36 dB (C-
weighted) is the maximum possible using ear muffs and earplugs simultaneously, equating to only a 36 -
7 = 29 dB(A) protection.[44] Some high-end, passive, custom-molded earplugs also have a mechanical
filter inserted into the center of the earmolded plug, with a small opening facing to the outside; this
design permits being able to hear range commands at a gun range, for example, while still having full
rating impulse noise protection.

Such custom molded earplugs with low pass filter and mechanical valve typically have a +85 dB(A)
mechanical clamp, in addition to having a lowpass filter response, thereby providing typically 30-31 dB
attenuation to loud impulse noises, with only a 21 dB reduction under low noise conditions across the
human voice audible frequency range (300–4000 Hz) (thereby providing low attenuation between shots
being fired), to permit hearing range commands. Similar functions are also available in standardized
earplugs that are not custom molded.[48]

Derating in several countries

Country, organization Roll-down foam earplugs Pre-molded earplugs Earmuffs

USA, OSHA 2 times reduction 2 times 2 times

USA, NIOSH 2 times 3.3 times 1.33 times

Italy 2 times 3.3 times 1.33 times

UK 4 dB reduction 4 dB 4 dB

France 10 dB 10 dB 5-7 dB
Germany 9 dB 5 dB 5 dB

The wide variation in recommendations[2] may be due in part to the very large inter-individual variability
in results that cannot be predicted; but can be taken into account by individual measurements.

Expected updates
In 2007, the American National Standards Institute published a new standard for noise reduction ratings
for hearing protectors, ANSI S12.68-2007. Using the real ear attenuation at threshold data collected by a
laboratory test prescribed in ANSI S12.6-2008, the noise reduction statistic for A-weighted noise (NRSA)
is computed using a set of 100 noises listed in the standard.[49] The noise reduction rating, rather than be
computed for a single noise spectrum the NRSA incorporates variability of both subject and spectral
effects.[49] ANSI S12.68 also defines a method to estimate the performance of a protector in an atypical
noise environment.

Building upon work from the U.S. Air Force and the ISO 4869-2 standard,[50] the protector's attenuation
as a function of the difference in C and A-weighted noise level is used to predict typical performance in
that noise environment. The derating may be quite severe (10 to 15 decibels) for protectors that have
significant differences between low and high frequency attenuation. For "flat" attenuation protectors, the
effect of C-A is less. This new system eliminates the need for calculators, relies on graphs and databases
of empirical data, and is believed to be a more accurate system for determining NRRs.[49]

Personal attenuation rating (PAR)

Similar to a noise reduction rating
(NRR) required on hearing protection
devices in the United States, a
personal attenuation rating (PAR) can
be obtained through a hearing
protection fit-testing system.[7] The
PAR is subtracted from the measured
noise exposure to estimate the total
noise exposure an individual is
receiving when wearing hearing
protection. The PAR is regarded as
more accurate than the NRR because
Fit testing (MIRE)[51] it is calculated per individual and per
hearing protection device, while NRR
is a generalized estimate of potential
sound reduction based on the protection provided to a small population of people.[52][38]

In order to achieve significant attenuation, fit-testing and extensive personalized (one-on-one) training
was found to be essential, whereas simple instructions did not lead to significant attenuation ove giving
no instructions at all.[53]

Health risks
Earplugs are generally safe, but some precautions may be needed against a number of possible health
risks, with additional ones appearing with long-term use:

Pushing in earplugs into the external ear canal may cause the air pressure to rise in it, in
effect pushing against the eardrum and causing pain. This may be caused by pressure on
the ear while lying down on the side, and is also the case when completely expanded foam
earplugs are pushed further into the ear. To bypass the latter risk, such earplugs are instead
removed, compressed and inserted to the desired depth. Vice versa, when pulled out, the
resultant negative pressure pulls the eardrum. Therefore, some earplugs are better carefully
screwed or jiggled out rather than yanked out. Yawning does not help to equalize this air
pressure difference, since it equalizes the pressures between the middle ear and the
 environment, while this overpressure rather is located in
the outer ear, between the eardrum and the earplug.
If pushed too far into the ear canal, they may push
earwax and debris into the canal and possibly against
the ear drum.[54] As a precaution, earplugs should not be
pushed further into the ear canal than they may be
grabbed and rotated.[55] Earwax impacted by earplugs
can be removed by irrigation or other remedies, as
described here.
There is a possibility of allergic reactions, but this is
likely rare, as earplugs generally are made of Earplugs are a form of hearing
immunologically inert materials. protection

Long-term use
Custom shaped plugs are recommended for long-term use, since they are more comfortable and gentle to
the skin and will not go too far into the ear canal.

Nevertheless, prolonged or frequently repeated use of earplugs has the following health risks, in addition
to the short-term health risks:

They may cause earwax to build up and plug the outer ear, since it blocks the normal flow of
earwax outwards.[56] This can result in tinnitus, hearing loss, discharge, pain or infection.[56]
Excess earwax should be carefully removed from the ear, and earplugs should be cleaned
regularly with water and mild soap. However, foam type earplugs are usually designed to be
disposable, and will expand and lose their memory property upon drying after washing with
water and soap. From then on, they will expand very quickly after being compressed,
making proper insertion into the ear canal quite problematic. They also lose a large
proportion of sound attenuating capability after such washing and drying.
They may cause irritation of the temporomandibular joint, which is located very close to the
ear canal, causing pain. Individually fitted non-elastic earplugs may be less likely to cause
this irritation compared with foam ones that expand inside the ear canal.
Earplugs are also a possible cause of ear inflammation (otitis externa), although the short-
term use of earplugs when swimming and shampooing hair may actually help prevent it.
Still, many pathogenic bacteria grow well on warm, moist, foam-type plugs (polyvinylchloride
(PVC) or polyurethane). However, there need also be a loss of integrity of the skin for
infection to occur. Hard and poorly fitting earplugs can scratch the skin of the ear canal and
set off an episode. When earplugs are used during an acute episode, disposable plugs are
recommended, or used plugs must be cleaned and dried properly to avoid contaminating
the healing ear canal with infected discharge.

See also
Hearing protection fit-testing
Noise-induced hearing loss
Occupational hearing loss
Safe-in-Sound award

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External links
OSHA's letter of interpretation on hearing protection-fit-testing ([Link]
egs/standardinterpretations/2017-10-20)
Royal National Institute for Deaf people ([Link]
National Institute for Occupational Safety and Health - Hearing Protector Device
Compendium ([Link]
NIOSH Science Blog: NIOSH HPD Well-Fit™: The Future is Fit-Testing ([Link]
v/niosh-science-blog/2013/05/31/well-fit/)
DOD, 2024 policy on hearing protection fit-testing ([Link]
Sheets/2024/01/09/Hearing-Protector-Fit-Testing-Requirement-in-the-DOD) US Department
of Defense

Retrieved from "[Link]