Mr. Greenwald's advice worked for my MBA 2.13 GHz/OS 10.5.8. Been having problems for a couple of days, plonked down the dosh for the phone support, which TEMPORARILY got the problem fixed with Disk Utility verifying and repairing permissions, then shutting down and doing the reboot: (1) shift-control-option-power (no response, which is as it should be), then (2) power button, followed by simultaneously hitting control-option-P-R. That worked, as I said, for a while, but the same thing kept happening. Sound would disappear, icon would disappear, and the whole shebang: no internal speakers showing up in Sound preferences/Output.
I tried a few of the other software tips in the thread above: p. 4 said something about deleting a Library/Preferences/com.apple.BezelServices.plist file. Did it. No results.
When I shut down, then held "D" down as I repowered, everything just came up as usual. No bong. I saw no evidence of any "diagnostic mode," until I went to About this Mac/More info/Diagnostics, and saw that indeed diagnostics had been run when I powered up. So, I shut down, did the reboot, and got the Bong.
This time it was different: my volume icon was there! Every other time I have rebooted, IF I got the Bong, I had to go into Sound Preferences and tell it to display my volume control.
Now what I'm trying to remember is: when I did my final reboot, was it a control-option-P-R reboot (see above). I think it was.
Either way, iTunes is playing happily now, and so far so good. Hallelujah! That's fixed it. Thanks, Mr. Greenwald.