I use a custom-molded pair of earplugs. it's just a rubber mold with an Etymotic filter that cuts out 25 dB. I got the mold made at the Northeastern University Medical Centre in Boston when I lived there. Cost me US$75 incl filters. Very easy care, just wash the mold when it get's crusty.
The difference between the ready-made and the custom earplugs is the distance the plug goes. Custom ones reach the 2nd bend. Definitely more isolation, yet clarity.
I totally recommend it. Worth the investment. You can get the moulds done in NUH Audiology Department (get a referral from Polyclinic, it's cheaper that way), or private Audiologists who make hearing aids. Sites like Etymotic, or Ultimate Ears have specs for the moulds.
I got them because I was practising drums a lot in a very small space. I was told that the woodwinds section of the Boston Symphony all wear 'em cuz the horns behind are very loud. So if the classical guys are getting them, what more people like us.