This means I only have one bad choice. I can play without the screeching noises in battles, but not have full speech or sound effects, or I can have full effects but get screeching noises when a battle ensues! Nice choice, eh! Who would have thought in a late 2010 game you would be having to turn down sound acceleration! This what I have to do 10+ year old retro PC titles!
On the web I have seen answers to various sound issues that say to turn off sound acceleration altogether, or set the soundcard to 2.1, but they don't tell you about the voice or effect drop out when you do that!
I only have this problem with Fallout New Vegas, not with Fallout 3 or Oblivion. I also have no problems with sound on any of my other games like GTA IV or Mass Effect or Bioshock, etc!
I think this is a Bethesda/Obsidian not a Realtek issue, and that Bethesda/Obsidian should be talking to Realtek, because unlike graphic cards, when people always say what card they have, with sound issues few say what card, and I believe the majority of people that have sound problems are like me - using a Realtek card!