I've got an old Soundblaster card hooked up to a 2.1 "flat-panel" set of Monsoon speakers. Obviously, I'm not a serious gamer. For music, I run through Dolby Headphone processing into Sennheiser 497 headphones - remarkably good.
jtt283 mentioned being deaf in one ear. My daughter is deaf in both. So let me tell you her setup. She plugs one end of a $150 stereo-to-mono cable into the PC, and the other into a jack on the processor ($6,000) for her cochlear implant ($52,000). It's a little spooky, sometimes, seeing her plugged directly into Itunes, signals straight to the brain with no sound waves involved.
Anybody else running a $58,000 sound system? At 1.0?