The present disclosure provides communication systems and devices for use in noise environments, such as during magnetic resonance imaging (MRI). In some embodiments, a communication headrest is provided that consists of a headrest that supports a patients' head, an optional bone conduction microphone, and one or more vibration actuators. The headset makes contact with noise-isolating earplugs worn by the subject such that vibrations generated by the vibration actuators are transferred through the earplug, via acoustic conduction, to enable the patient to hear audio content while the earplugs provide passive noise protection by occluding the ear canal. In other embodiments, active earplug devices are provided in which an acoustic transducer is contacted and supported by a noise isolating earplug, such that when the earplug is inserted into the ear canal, the acoustic transducer is brought into acoustic conductive communication with tissue surrounding the ear canal, facilitating acoustic communication through bone conduction.