No audio output from Premiere 5.5.2 (Mac)

I have had typical intermittent sound issues using Premiere on OSX (10.7.4) which have been easily fixed. Now, none of the audio outputs are working.

Audio meters are working fine, you can export files with audio, you just cannot monitor audio while in Premiere. Audio is working normally from FCP, After Effects, literally everything except Premiere. Is it a driver issue (which have not changed) or something that a fresh install might fix? I'm at a loss.

Any help is appreciated, let me know if this isn't enough info.