To determine the prevalence of hearing loss (HL) in patients with ankylosing spondylitis (AS) and to describe frequency-specific hearing threshold changes in this patient population compared to patients without AS.A systematic review querying four databases (PubMed, Ovid MEDLINE, SCOPUS, Cochrane) was performed to identify studies evaluating HL in patients with AS. Meta-analysis was performed to identify overall prevalence rate and odds ratio (OR) of HL, as well as to compare mean differences in frequency-specific hearing thresholds between patients with and without AS.This meta-analysis included 14 studies and 1,083 patients (598 with AS vs. 485 without AS). The pooled prevalence of HL in patients with AS was 42.4% (95% CI 29.2 - 56.2%). Patients with AS had a significantly higher OR of HL in patients with AS over patients without AS (4.65 OR, 95% CI 2.73 - 7.91). Mean differences in pure tone hearing thresholds ranged from 0-5 decibel (dB) for frequencies 0.25-4kHz and from 5-15 dB for frequencies 6-16 kHz.Patients with AS have higher odds of having HL over patients without AS. This population also presents with significantly impaired hearing thresholds across all conventional and extended pure tone frequencies. This may manifest as slight to moderate hearing loss. Results of this systematic review might justify increased attention audiologic manifestations of patients with AS.