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If you have boated for any length of time, chances are that you have had, or currently are having some sort of ear issues.  This can range from water not draining, ear infections, vertigo, and other unpleasant conditions.
Ear plugs should be a part of any boaters kit but finding the right ones for whitewater use can be a challenge.  They either block too much sound and isolate you, are uncomfortable and annoying to wear, fall out repeatedly, don’t drain properly, let too much water in, or are so much hassle to use that they are easier to just leave in your PFD pocket.
The reason we all should be using earplugs is simple.  We spend a lot of time upside-down and it is usually in cold water.  Exposure to wind and cold water causes the bone surrounding the ear canal to thicken and constrict the ear canal, sometimes to the point of complete blockage (“occlusion”) which can lead to substantial conductive (caused by blockage) hearing loss.
I have used almost every type of earplug on the market and below is a review of each type with my absolute favorite on the bottom.  They are in descending order of my preference:
Custom Earplugs
After years of infections, water draining issues, and the like I went to an audiologist and paid over $100 for a custom set of earplugs-plus the office visit charge.  I hated them.  They did not fit, did not keep water out, and while I think that they were silicone, they were very hard and bulky and impossible for me to wear more than a few minutes.  They even made a second pair for me with minimal improvements so they sit in my drawer.  I feel that there are significantly cheaper and better options out there, but again, this is a personal opinion.  
Cons: Expensive.  Didn’t work for me.
Mack’s Silicone plugs—a pliant blob of silicone that totally blocks the ear canal.  While effective, you hear almost nothing and your balance seems off; not a good combo for whitewater boating.  They were actually very effective as plugs but the hearing loss and isolation was a deal breaker.  
Pros: Cheap. 
Mack’s Ear Seals—these are the plugs with 4 soft circular ridges that fit into the ear canal that theoretically block out the water.  If seated, they do totally block the water but as a result you are left with little or no hearing.  I tend to wear them a bit loose with mixed results in terms of keeping water out…but I can hear better.  Fairly comfortable but after a few hours they get to be irritating.  
Pros: Cheap.  
Doc’s Pro Plugs—Surfers made them famous-they cover the outer canal better than the ones above and rest more on the outside of the ear with one circular seal for the main canal.  Over time in the day and over multiple days, I find them uncomfortable and irritating.  I lose them regularly and contrary to what they claim, they do not float.  If you get the vented ones you hear a bit better than the Mack’s above but water can also get trapped behind them and I seem to always be fussing with them to clear them.  They can be purchased with a leash but it pulls out quickly so I suggest not buying them as they stay in the ear well if properly fitted without the leash, and they do come in many sizes to accommodate different size ears and ear canals.
Pros: Works fairly well if you get the correct sizing.  
TYR Silicon Molded Ear Plugs—these are exactly the same as DOCs and if anything, are more comfortable, maybe they are softer silicone.  You can find them for around $3 which makes them highly recommended in my book.  They do have the same issues as Doc’s but the price offsets the hassle IMO.  These are my second favorite ear plugs and I used them exclusively until I found the plugs below. 
Pros: Cheap.  Works pretty well and not so tragic if you lose them. 
Surf Ears by Ear Labs—These plugs are incredible.  It took me a while to pull the trigger to buy them ($60) but after reading the reviews and understanding their concept of managing water and hearing, I gave it a go.  The concept is simple but it works.  Basically, they use a hydrophobic (water shedding) super fine mesh seal over the outer plug to keep water out of the canal and are seated in the ear with a comfortable silicone wing holding them in place.  They come with small, medium, and large inner canal seal pieces and two sizes of the outer holder/fitting pieces.  They are pretty comfortable for long term/all day usage, keep virtually all water out when you get the right combo of inner and outer pieces, and hearing is only impaired a bit—when first surfacing you sometimes get the boy in the bubble sensation but the mesh clears fairly quickly and hearing is back to almost normal quickly.  You can fiddle a bit with them, tap them, etc. to hasten this process but I found that shaking my head or just dealing with the slight blockage for a bit is the easiest way to get them to clear.
Pros: They actually work and you can hear!
So there you have it, my history and progression of earplugs through the years.  Anyone who has had their ears drilled knows how important it is to keep water out of your ears, but like anything else, it isn’t a problem until it is, and by then it is usually too late.  WEAR YOUR EARPLUGS!
Happy paddling,