As I'm an audio engineer I depend on my hearing to stay in a job so I have an particular interest in this. Although I try and read on the subject I'm not an audiologist or a doctor however.
In many industrial situations the factor that results in most exposure to noise is either not wearing the plugs or fitting them too late - i.e. spending some time exposed before you remember or similar. There is also a big problem with incorrectly fitted plugs - people don't put them in correctly. Custom molded plugs can help with this as they can be comfortable, encouraging people to wear them, and it tends to be difficult to not put them in correctly. Some people find they do get custom molded plugs that simply will not fit well are are uncomfortable, so a custom mold isn't a solution to the comfort and fit problem in every case.
However, because custom molded plugs are, basically, relatively stiff plastic they don't make a very good seal, if they made a perfect seal you could never get them in and out, and so they will always offer less attenuation than foam plugs as when you put a foam plug in it expands to fill all the voids and so forms a very good seal. So for absolute noise reduction foam plugs can be a better choice. The problem with foam plugs is that you often have to try a few different types before you get something comfortable and that fits well for you and most people don't realize this and so just use the first thing they find, which has a pretty low probability of working well for them especially in terms of comfort. Foam plugs are also very isolating and many people find this disconcerting.
It may be worth your while looking at some of the electronic options that have a foam ear tip as these can combine the best of both worlds - they have a foam ear tip that gives a very high attenuation but the electronics allows you to carry on normal conversations etc. Alantoo who posts on this forum went with the Peltor/3M LEP-100 electronic plugs and his comments lead me to give them a try as well and I've been impressed, they aren't cheap, but I've found them very effective in the field and they offer very high levels of attenuation. They don't need custom molds etc. as they use foam tips to insert into your years and the electronic bit sits in your ear quite comfortably. As with any foam tip I would suggest that you need to try a few different versions to get something that works for you to offer maximum comfort and there is a good range that will fit the LEP-100s, and probably other similar devices. They ship with the "christmas tree" type flange plugs, which are awful in my view and have never worked for me, and also some foam plugs which are on the large size. If you get a foam earplug that is uncomfortable or doesn't fit well then it will simply not work for you but I now have several options for the LEP-100s.
The LEP-100s have an internal rechargeable battery which means no changing of batteries and they have a very neat and robust case which also acts as a charging station. It is quite an interesting and effective solution as they offer about 16 hours run time on a charge so unless you shoot for more than 16 hours at a time this will not be a problem but, clearly, there is also a certain advantage in just being able to change a battery. I keep the case in the car when shooting and simply pop them into it if driving between areas or whatever and the charger will run off AA batteries or the USB from a phone charger or even your car.
3M PELTOR LEP-100-EU Level Dependent Earplug Kit Get hearing protection and improve situational awareness in potentially noisy environments. Integrated with state-of-the-art level-dependent technology, the LEP-100 EU amplifies weak sounds whilst noise, including sudden loud noises like a gun...
www.earshotcommunications.co.uk
CENS (perhaps the most popular in the shooting field due to their marketing) also make a foam ear tip type electronic plug, I wanted to avoid CENS but it is another option for you:
Mino CENS Universal Electronic Hearing Protection Mino CENS offers shooters an affordable way to experience comprehensive CENS digital electronic hearing protection. Effective hearing protection for only £299! Buy Now Buy with confidence Buy Your Mino CENS Now! Universal electronic ear plugs...
www.censdigital.com