The mean platelet volume (MPV), red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) comprise laboratory markers in ankylosing spondylitis (AS). There is a controversy in the literature regarding which type of ear involvement is characteristic of AS. The aim of this study was to simultaneously investigate the MPV, RDW, platelet to lymphocyte (PLR) and NLR in patients with AS and their relationships with high-frequency hearing thresholds. Thirty patients with AS and 35 age-matched healthy subjects were included. Each subject was tested with low- (250, 500, 1000 and 2000 Hz) and high- (4000, 8000, 10,000, 12,000, 14,000 and 16,000 Hz) frequency audiometry. Additionally, the case and control groups were evaluated regarding the average hearing thresholds in bone conduction. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured. The RDW, MPV, neutrophils, lymphocytes and platelet counts were evaluated with the complete blood count. Furthermore, the NLR and PLR were calculated. The complete blood count, platelet numbers, ESR, CRP and NLR levels were significantly increased in the AS patients compared with the healthy controls (p < 0.001, p = 0.007, p < 0.001, p < 0.001 and p = 0.047, respectively). There was no statistically significant difference in the RDW, PLR or MPV levels (p > 0.05) in the AS patients compared with the healthy controls. The BASDAI score and disease duration were not correlated with the ESR, CRP levels, MPV, PLR, RDW or NLR in patients with AS (all; p > 0.05). The AS patients had increased average measurement values for the hearing threshold in both ears at frequencies of 250, 500, 1000 and 2000 Hz; however, there was no statistically significant difference (p > 0.05). The average values of the hearing threshold in both ears at the high frequencies of 4000, 6000, 8000, 10,000, 12,000 and 14,000 Hz were significantly increased in the case group; however, it was not significantly increased at 16,000 Hz. The current study is the first to investigate the PLR, NLR, MPV and RDW levels in acute AS. We identified a significantly increased NLR, leukocyte count, ESR and CRP in AS patients. Sensorineural hearing loss, especially at extended high frequencies, is common in patients with AS and may represent an extra-articular feature of the disease. The combined use of NLR with the leukocyte count and other clinical assessments may facilitate the diagnostic process of ankylosing spondylitis.