No. 1 doctor recommended. Maximum comfort. Hypoallergenic. Original formula. Snore proof. Water proof. New easy-to-open shatterproof case. Helps prevent swimmer's ear. Noise reduction rating 22 dB. Swim, sleep, study, shower, work, travel, sports, loud events, flying discomfort, etc. Safe for use with ear tubes. Recyclable package. www.MacksEarplugs.com. The original & exclusive formula made with non-toxic, hypoallergenic silicone putty. Official earplugs of USA swimming. CE listed. Noise reduction rating: 22 decibels (when used as directed). The range of noise reduction ratings for existing hearing protectors is approximately 0 to 30 (high numbers denote greater effectiveness). Federal law prohibits removal of this label prior to purchase. EPA label required by USEPA regulation 40CFR part 211 subpart B. Made in USA.