Two weeks now with the Zotac 4090 Extreme Airo and overall I'm really happy with the card, driving 2x 4k screens, 1x 60hz and one 144hz and the fans never come on even when watching 4K content. No coil whine on mine that I can hear and I really hate noise like coil whine, and when the fans do spin up they are pretty quiet, my case fans which are the newer Corsair ML fans with 8 LEDs drown the card out.
When gaming the card spends the majority of the time at a 30% fan speed but it's pretty rare to see it it go over 40% and this is in an Phanteks Evolv X case with a custom front panel for more airflow, but still not a great case for keeping things cool but the heatsink on this card is doing a great job. Card is usually at 55c to 65c when gaming in games like The Division 2, Destiny 2 and Uncharted Legacy of Thieves Collection.
Out of all the Nvidia cards I've had over the years whether AIBs or Founders this is the coolest and quietest card that I've had so far, really impressed with the cooler.
Over the years I've had routers and even Logitech MX mice which have had coil whine and plenty of GPUs that have sounded like a bees nest so I can pick up even quiet coil whine pretty well and this Zotac is honestly very quiet.