I spent my first 10 years in the USAF on the flightline working on F-4s and A-10s with long and constant exposure to noise levels above 140 dB esp., during sortie generation. Back then, all we had were foamies and headsets. The recommendation was to use both, but most only used one; some did not use any; I did both. Some of my friends that did not use the proper hearing protection had hearing loss/ear damage. My hearing was nearly the same as when I enlisted.
I wear protective gear (hearing protection, gloves, safety glasses - Mom nearly lost an eye chopping wood, etc.) at home, mowing, snow, and leaf blowing, and operating high noise level home tools and equipment.
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