I'm using a Geforce 6600LE on a CRT tv via a svideo cable. I've had issues with tearing since building my cab. Turning on vsync fixes this, but then the sound stutters for some games. A good example is Wonderboy. I've since tried various settings and even tried cabmame, but could never fix it.
This weekend I decided to install Windows 7 64bit instead of XP 32bit I've been using so far. I installed Windows on a new drive, then the Nvidia Drivers, then HyperSpin and Mame64.
Tested Wonderboy = tearing.
Enabled vsync = tearing gone and sound perfect.

I did have one other problem, a white line at the top of the screen, which I didn't have on XP. So I started checking settings. Problem turned out to be a PAL/NTSC issue. If it's on NTSC, I don't have a problem with tearing. If it's on PAL, I get tearing again, or sound stuttering with vsync on.
I also noticed that on Windows 7, with NTSC the refreshrate is 29 and PAL is 30, while on XP both shows 60? Any idea why?
I've sinced put the XP drive back. If I change to NTSC, I get the white line at the top of the screen as well, but it's not there with PAL.
So... only way I don't have the white line, is if I stay on XP on PAL. But then I have tearing (or sound issues with vsync). Is it maybe the refresh rate causing it? Can it be changed somewhere, since I can't change it in the Nvidia Control Centre or in Windows?