So at the urging of my buddies, who find this remarkably funny, I figured I'd tell ya'll a story, and give a nice tip if you're having trouble with directional sound in this game.
I picked up Tarkov a couple months back, and love the game. Been playing very actively, but one thing I always struggled with was the directional sound. No matter what I'd do, what settings I'd change, I could not for the life of me figure out what direction sounds were coming from. I'd think I was hearing footsteps to my left, then the guy would be on my right. Same for front to back. It was driving me crazy, but I was still able to "mostly" do OK, even handicapped with the sound issue. I dug through forums, this sub, tweaked settings, and nothing seemed to work. I constantly bitched to my buddies when I'd die from not being able to tell where enemies were coming from. It was remarkably frustrating.
Then, a few days ago, I happened to be in my sound settings for something completely different, and happened to hit the little speaker icon when you're testing your headphones in windows. The chime for the left side came out of my right, and it instantly clicked. For reference, I have a pair of ASTRO A40's, and the design is reversable. You can even swap the mic from one side to the other. I always kept my headphones on the same way, with the cable on my right to connect to my computer, since I didn't want the cable draped over me when I'd be leaned back in my chair. Turns out, while the headphones are reversable, there's still directional sound from left and right depending how you wear them. I'd been wearing my headphones backwards for years, and didn't realize since I never really played any other games with directional sound. Once I put them in correctly, it was a night and day difference. I'd gotten so used to trying to deal with fights without reliable sound, that it almost feels like cheating now that I know exactly where people are in a fight.
So, TL:DR, if you're having trouble hearing directional sound, make sure your headphones are on correctly, and don't be a dumbass like me.