Failed to init FMOD system. Error 51.

I am getting this error on startup. I ran packcheck, have restarted multiple times, and checked all my audio drivers.

My sound works fine with everything else. Does anyone know of a fix for this or do I need to reinstall?

Thanks.

I'd try renaming production_Config.ini in Documents\My games\Path of Exile to something else so the game generates a new file on its attempt to boot. If that doesn't help you can delete the new one and change the original file back and keep all your settings.