The Zika virus (ZIKV) infection in pregnant women has been associated with an increased risk of birth defects. We aimed to estimate the prevalence of sensorineural hearing loss (SNHL) in infants exposed to the ZIKV during their gestation and evaluate the factors associated with its increased odds.A cross-sectional study was performed from July 2016 to June 2019 in a Western state of Mexico and data from 61 infants that presented with laboratory-positive (RT-qPCR) evidence of in utero exposure to ZIKV were analyzed. Brain stem auditory evoked potentials were used.Hearing loss was documented in 6 (9.8%) of infants. The prevalence of SNHL in children with microcephaly was 75.0%, as compared to 5.3% in those without anomalies (odds ratio, OR = 14.31, 95% CI = 2.54 - 19.12). Half of children with SNHL had no physical manifestations of gestational ZIKV exposure.Hearing loss was a frequent event in ZIKV-exposed children, particularly among those with microcephaly. Our results highlight the relevance of systematic hearing screening.Copyright (c) 2021 Erika J Verjan-Carrillo, Efren Murillo-Zamora, Gabriel Ceja-Espiritu, Jose Guzman-Esquivel, Oliver Mendoza-Cano.