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I've been using the Shure PSM600 with the E1 ear buds for a while now and they're very good in most situations,
At first I thought the molded earpieces would be the way to go but the problem with too much isolation is it's too easy to loose the beat. Makes it difficult to play along with the other players. It's possible to mix in the rest of the band but that's easier said than done. It was difficult for me to get a mix that was satisfactory (sound techs don't have patience) and you still have to be above the others volume wise.
My favorite earpiece is the Shure one that is soft clear plastic that looks like a small mushroom. The more you push them in the better the isolation. I'll have them in loose so I can still hear the other players and when the volume goes up I'll push them in more.
The biggest problem I've had which I've never seen anyone else mention is that when the stage volume is very high most of that sound makes it's way through your mike and back into your IEM. No amount of earpiece isolation will help this.
In extreme volume situations this can render IEM's useless. That's when you need sound filters or ear plugs. I've walked outside of a club on a song I didn't play on and the noise coming from my IEM was so loud that I couldn't hold a conversation. That was with just me in my IEM mix.
Speaking of sound filters, if you've ever used them you'll know that there is a learning or adjustment period you go through. You'll find the same thing with IEM's.
Like Tenorman said, they are still better than floor monitors.
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