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There were a few fixes, but this one ( http://newvegas.nexusmods.com/mods/35868/? ) is probably worth a try. Make sure you read the instructions and how to reverse the process if it doesn't work or does something not intended.
Also, the game doesn't like USB speakers/headsets and non-stereo setups. It is always worth a try to set your audio setup to 2.0 stereo in WIndows control panel.
I think this is an issue with windows 8 and 10. I did reinstall all of my audio drivers nothing... this is the only game that is doing this ♥♥♥♥. I am on windows 10 pro N with a Razer Tiamat 7.1 headphone.
I don't have any razer drivers installed... the razer manual says my headphones are analouge and should work directly when I plug it. I set it to 2.0 stereo still nothing. Although I have this ordinary headphone lying around I will check it out if it works there. BTW Skyrim works absolutely fine.
I installed a moded radio from nexus and it also skips / garbles the music wtf
♥♥♥♥♥♥♥♥
Had this exact problem, Steam Proton in Linux, two Nvidia GPU over HDMI (AMD GPU over HDMI was fine). Information at https://www.reddit.com/r/fnv/wiki/premoddingguide suggests using LAV Audio Decoder. I used manual x86 version extracted to steamapps/common/lavfilter and ran install_audio.bat. It fixed the issue!
If it works for Steam Proton in Linux, it's a good bet it'll fix anywhere.