Quick answer:
The game ran at a different refresh rate than your monitor; thus the tearing.
Setting triple buffer or vsync plays the game at a different (refresh) rate than the sound is timed for, thus the sound problems.
IIRC, if you set the windows desktop refresh rate greater than the original game, this helps with the sound & triple buffer, but you'll get a screen repeated for two frames once in a while.
I don't mess with video settings much, though, so grain of salt.