I run a Medusa 5.1 headset off an Audigy Sound card (non uSB). With the headset on the surround sounds are not as good as through the speakers but miles ahead of a stereo set of headphones. There are a couple of "black holes" when you pan your head around which I have yet to remove.
One thing I found was to ensure that you have 5.1 speakers set in both windows (Control Panel -->Sounds and Devices-->Advanced in the speaker sound settings) and your sound card application. In IL2 setup make sure you have Surround set.
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