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I loved these way back when it was a single size. Nowadays the standard are way too small (no noise suppression) and the large are too large (painful). Very disappointed. Buy small - no good. Buy large - still no good. Cut the third flange? Have not tried that so cant comment. I recently got Earasers musicians earplugs and am happy with how the medium size fits and works really well and better performance at loud concerts and on airplanes. If Etymotic could produce a medium I would still want some, they are slightly more convenient to put in and take out and are cheaper. The Earasers are better in other ways but finicky to put in. Might as well have different options for different needs.