Difficult room configuration with high ceiling - help!

I'm assisting my father in upgrading his entertainment setup - so with that said, the room where his existing stuff is setup is a really difficult configuration. Here are the known:

He wants:

• in-wall speakers - or atleast speakers that aren't laying around for his dogs to knock over. (he has a St. Bernard
• He wants a 50+inch LCD, most likely mounted
• He will be using the setup for listenting to music and watching movies

Challenges:

• The floor is ceramic tile - so no running anything under it
• The ceiling is very high - it runs the height of the 1st and 2nd story with an overlooking balcony/walkway above.
• There is a ceiling fan installed in this high ceiling room - which begs, how did they wire it up there if there is no basement?
• Do I assume that I have to run wire along the wall?

I've attached a basic layout of the room without dimensions. What do you guys think is the best way to achieve the best soundstage?