Professional musicians are often exposed to high noise levels and thus face the risk of noise-induced hearing loss. Yet, adoption rates for hearing protection among musicians are low. Previous surveys indicate that the chief concern is the effect of hearing protection use on performance. However, few studies have investigated actual changes in performance when wearing hearing protection. We report an experiment investigating differences in pianists’ performance and experience with and without hearing protection. We compare the effect of foam earplugs and musician earplugs, designed to preserve sound quality with a flat frequency response. The analysis revealed that participants performed overall more loudly with the foam earplugs than with the musician earplugs, and in turn performances with the musician earplugs were louder than the open condition, indicating a compensatory effect. However, this effect was stronger for novel excerpts than for familiar excerpts. No effect was observed on dynamic range. Furthermore, we observed an acclimatization effect, whereby the effect of hearing protection use, observed on the first performance, decreased on the second performance. In terms of experience, participants reported changes in coloration, difficulties gauging dynamics and articulation, and increased effort required when performing with hearing protection. These effects were more pronounced when wearing the foam earplugs, and the participants reported finding the musician earplugs more comfortable to wear and play with. In conclusion, hearing protection use affects pianists’ performance particularly in terms of dynamics and their experience more so in terms of coloration. But the effects are less marked for familiar pieces and after repetition, suggesting that pianists can quickly adjust their playing when playing familiar pieces with hearing protection.