Have you confirmed that spatial sound is turned on in your system sound settings?
This can take a bit of digging to find. On Windows 10 you might find it in your sound settings on your taskbar. Or if you have Realtek sound you might find it via your Realtek properties settings. Keep hunting until you find a way to turn on spatial sound, and double-check that you have changed "SoundUse=0" to "SoundUse=1" in conf.ini, even if you checked it before.
If you can start, but still have no sound, look at the Audio panel in your in-game Sound Setup and experiment with settings for Sound Engine and EAX settings etc. You should see red lights indicating what EAX level you are getting. My sound engine is set to Direct X and the EAX is set to Autoselect. Using the DSOAL_XP wrapper I can get EAX 4. Some other wrappers only gave me EAX 2. Also check the Volume panel to ensure your volume is not zeroed.
If none of that helps, please post the [sound] section of your config.ini and someone might be able to see what's going on.
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