I had the problem where speech and sound FX were delayed by 20-30 secs, if I heard them at all. A few fixes have been proposed and tried:
- Downgrade all the games settings to 'Wii style' graphics (looks terrible, and didn't work for me)
- Set the games priority to 'high' (for me this created the 'game randomly pauses for 5-20 secs every 1-2 minutes' issue while fixing the sound)
- Install Creative Alchemy if using a Sound Blaster card (didn't work for me)
- Install a D3D9 wrapper that fools the game into running with an earlier shader version (no effect for me: this is correcting for the wrong issue)

So I just tried setting the the game to a modest suite of graphics settings (basically medium), removing HDR effects, and then running the game in Windowed Mode.

It works.

I'm now goosing the graphics back up to what my card should support, and recommend that people trying this unlock and minimise their task bar in order to see the bottom of the windowed game (the quest indicator on the compass is otherwise obscured).

I should also mention that I've disabled steam cloud and steam community for this game, but this did nothing to correct the issue earlier.

Hope this helps someone else turn a $50 rip off into a playable experience.

I've found that playing in windowed mode solves the problem for me too, whether or not I change any other graphics settings. Thanks for sharing what worked.

But the point is this, why pay good money to only be able to play the game in windowed mode! They should and better fix all the problems without people having to resort to such pathetic things such as having no option to play it in windowed mode which would/does ruin the game!