Exceptionally Uncaught

After installing half a dozen codec packages, driver updates and other random bits of software, I finally got F.E.A.R. to work properly last night.

Turns out that this section was the key:

F. If you are using a Creative brand sound card and get poor frame rates when sound hardware acceleration is enabled, then check for a process called "CtHelper" in the Windows(R) task manager. If it's there, terminate it and try the game again. If this works, please contact Creative to learn how to permanently disable CTHelper. If CTHelper is not present in the list and the problem occurs anyway, then you will need to disable sound hardware acceleration in the Sound section of the game's options menu, or in the Windows control panel, or in DxDiag.
http://support2.vugames.com/fear/answer.aspx?ID=7323

Did you spot the answer? No, neither did I for a long while. I wasn't having a poor frame rate - I wasn't getting any sound. There wasn't any "CtHelper" process. But I figured I'd try anything. Using the DirectX Diagnostic Tool (open Run and type "DxDiag"), I bumped the Hardware Sound Acceleration Level down from "Full Acceleration" to "Standard Acceleration". And what do you know, the game all just works.

Golden.