METHODS: Hearing assessment using pure tone audiometry and TEOAEs wasdone for 3 adult middle-aged groups: Group A: 30 chronic active hepatitis C virus (HCV) patients receiving treatment with PEG- interferon and ribavirin, for at least three months; Group B: 30 chronic HCV patients who did not receive treatment; and Group C: 10 healthy normal hearers as controls.OBJECTIVE: to study the effect of Interferon and Ribavirin combination onhearing in chronic HCV patients treated with these medications.RESULTS: Group A showed mild high frequencies sensorineural hearing loss(SNHL) in (63.33%) of cases (unilateral in 36.67% & bilateral in 26.67%). Theonset was sudden in 6.67% of cases. Group B showed SNHL which was unilateralin 13.33 % of cases. All subjects in this study had present TEOAE. In group A theTEOAE Pass was 48.33%, and Partial Pass was 51.67% of ears. There was astatistically significant difference among the three groups as regards the hearing threshold at different frequencies and TEOAE overall wave reproducibility. This difference was found between groups A and B and groups A and C in both ears but not between groups B and C. This suggests that HCV itself did not affect hearing or cause outer hair cells damage as much as did the treatment used for the disease. Normal hearing ears of the unilateral SNHL showed lower pass rate (27.27%) than those of the bilateral normal hearing (54.55%), which suggests subtle changes in the cochlea.CONCLUSION: Interferon and ribavirin combination used in treatment of HCVpatients, could affect the cochlea causing outer or inner hair cells damage. So we recommend that the HCV patients should be aware of the possibility of occurrence of clinical hearing loss or sub-clinical cochlear damage from dual therapy with interferon and ribavirin. We recommend that the Egyptian Ministry of Health add 1 audiological testing and monitoring in the guidelines of treatment and follow-up of treatment in HCV patients, i.e. HCV patients, scheduled for dual therapy with interferon and ribavirin, must have their hearing and inner ears assessed by both TEOAEs and pure tone audiometry before, during and after cessation of treatment, as well as a long term follow-up.