I get the clicks in the main menu, I get the first hiss when entering combat mode, but my first shot is silent and all sounds after that are dead. I still hear in-game music but can hear no sounds. After quitting to main menu, I hear the clicks. Very annoying. No mods, and it seemed to be working fine yesterday. I can't imagine I failed to notice my sounds randomly dying until today. Any ideas?
Win XP SP3
Soundblaster X-Fi Extreme Music
Anything else?
It appears now that I cannot replicate any in-game sound. Menu and character creation buttons click fine, but I'm getting no sound when inside of the game. And yes, I've played with the volumes. Sound worked fine yesterday, and I've reinstalled. I'll try reinstalling again to see if I can get ANY sound.
Final: After more investigation, it appears my savegame was the problem. My newest character's save seems to have had the audio broken, however that works. Used the savegame when audio broke, and it stayed broken even if I made a new character. After my first re-install, I loaded old save, and audio was broken. 3rd reinstall, didn't use save, audio works. Very strange.

I may be starting to sound like an echo on these forums but;
It may be due to sound acceleration.
Run dxdiag, go to the sound tab, and reduce / turn off sound acceleration, then try to play the game. Note that this might not fix the sound problem for your savegames - the only way to know then would be to play the game and see if the problem reappears in a fresh game.
It's just that very often when there's a video playback / sound problem in older games it's due to the sound acceleration if you're running XP or Vista.