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I have a Tiny Music Box, which I have been trying out with a few different enemies. I noticed it doesn't seem to affect normal enemies, nor the first boss, Cleric Beast.

It looks like it affected the 2nd boss, Father Gascoigne, though. He covered his ears for a brief second, but I wasn't close enough to attack him afterwards.

I wonder if someone can shed some light on how to effectively use this item?

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You should use it in the third and final phase of the Father Gascoigne encounter. If you're able to fully complete the animation -- I believe it takes a second or two -- Father Gascoigne will be stunned for a few seconds. You should have enough time to get in a few attacks, or lob an Oil Urn followed by a Molotov Cocktail for heavy damage.

If there are any other uses for the music box, I haven't encountered them yet.

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    According to the fextralife wiki, you can also use it on another boss fight, and it makes it sidestep (seems pretty useless but it is another use for it). You can see more about it on this page bloodborne.wiki.fextralife.com/Tiny+Music+Box (be careful as the wiki may contain potential spoilers for the game, including this particular boss).
    – kerwan
    Apr 5, 2017 at 9:22

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