Whenever given the opportunity, I immediately yank PulseAudio and replace it with a properly configured JACK+Alsa rig. This happens mostly on the workstations of musician friends who think they are being clever by using an enterprise Linux distro like RedHat, instead of an audio-specific distro like kxStudio or UbuntuStudio - the former is guaranteed to be a headache, the latter is smoother than anything else out there ..