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I don't see the point of these.
You can get Etymotic ER20XS, with a pullout tab that does work, multiple sized tips and a similar or better frequency curve, for about $20 on Amazon.
The old favorite Ety ER20 has the same frequency response, with a longer hard plastic stem and one size. They are only $12-14 on the Etymotic site and about the same at Amazon. You have to know your ear canal size.
They have exactly the same sound signature. I know this both from trying them out and from correspondence with Etymotic. The difference is that the Er20XS comes with different sized removable tips (so you can see which works best for you), has a shorter stem (not as visible) and has the little tab to pull it out. The basic ETY plugs have a longer stem and have non-removable tips in a fixed size: S, M or L.
That Amazon reviewer sounds a little...strange. There is no "insertion tool." The plugs are shorter in length but no smaller in diameter than the regular ETY. The sound signature is not wildly different from the ETY. (To me, and according to Etymotic, they are exactly the same). Maybe the reviewer put on the smallest tips and jammed them in--or jammed in the tips without the stem? or thought the stem was the "insertion tool?"--but the disaster described is not standard use.
If a doc told the reviewer that removable tips are inherently dangerous, the doc has never seen the countless IEM headphones that have, yes, removable tips, so they can fit the greatest variety of users. Here's one with 10 pair.
Yes, removable tips can eventually come loose--they have on my IEMs--but big deal, you pull (tweezers) or pry (headphone plug) them out and replace them. Meanwhile, I've been using my EtyXS pretty frequently and the rubber stem of the removable tip is relatively long (compared to IEMs) and quite grippy, both flexible and tight. It may eventually loosen but there's no sign after months of use.
I don't think the XS are worth the extra cost over the ETY, so if you've got the right fit you made the right choice, but....Amazon people can be bonkers.
the Amazon review was for Alpine Musicsafe earplug btw, not for XS.