Akira Yamaoka composed the music for Silent Hill 2. At his home, Yamaoka took three days to write the music for "Theme of Laura", Silent Hill 2's main theme, by combining "a sad melody" and "a strong beat", although he does not consider the melody to be the "most important" element of a musical piece. He wanted the music to evoke emotions in the player. Silent Hill 2 makes extensive use of sound effects ranging from screams to footsteps on broken glass. In charge of the game's fifty sound effects, Yamaoka wanted to surprise the player with different sounds and create an unsettling environment. He also incorporated occasional silence, commenting that "selecting moments of silence is another way of producing sound".
Konami published Silent Hill 2 Original Soundtracks in Japan on October 3, 2001. Eight tracks ("Theme of Laura", "Null Moon", "Love Psalm", "True", "Promise", "Fermata in Mistic Air", "Laura Plays the Piano" and "Overdose Delusion") appeared in the 2006 PlayStation Portable release The Silent Hill Experience. At the 2006 Play! A Video Game Symphony concert in Chicago, Illinois, Yamaoka performed music from the series, including "Theme of Laura", with a full-size orchestra. In 2019, the soundtrack was re-released on vinyl by Mondo, who previously gave the same treatment to the soundtrack of Silent Hill in 2016.