If the false response counter has not exceeded the predetermined limit, then the pure tone intensity module continues at step  717, where it determines whether the patient responded before expiration of a post presentation timeout period. The post presentation timeout period allows some time for the patient to respond even after the tone pulse train has stopped. This timeout period may be in the 0 to 2 second range; in this embodiment, the time period is set to about 0.5 seconds If the patient does respond before the post presentation timeout period expires, then the pure tone intensity module determines at step 718 whether that response occurred while the intensity level of the tone was off The intensity level is turned off if the lower limit of the equipment has been reached and still no threshold has been found. This means the patient is probably trying to guess of anticipate the tones, as he could not have heard any tone while the intensity was turned off The pure tone intensity module thereafter proceeds to issue the false response warning at step 715.
If the current threshold detection is not the first threshold detection, the threshold detection module proceeds directly to step  1007 to determine whether the current intensity level is greater than the previous intensity level, i.e., greater than the intensity level used the last time the threshold detection module was called. If it is greater, then at step 1008, the threshold detection module determines whether the number of responses at the current intensity level exceeds the minimum response count. If it does exceed the minimum response count, then at step 1009, the threshold detection module determines whether the number of responses at the current intensity level ( ) is greater than the number of non-responses at this intensity level (NR) If (R) is not greater than (NR), then at step 1010, the threshold detection module determines whether the ratio of the number of responses at the current intensity level (R) over the total number of responses at intensities within 15 dB of this intensity (T) is greater than the minimum response ratio. In some embodiments, the minimum response ratio is set to one-half, but may be adjusted higher or lower as needed. The ratio (R)/(T) can indicate whether the responses are being clustered or grouped together around a certain intensity level, which may indicate the patient has a threshold at that intensity level.
At step  1206, the set speech masking levels module determines whether this new masking level is so loud as to cross over and mask the test ear. If it is, then at step 1207, the set speech masking levels module sets the new masking level just below the maximum masking level calculated above. Otherwise, at step 1208, the set speech masking levels module determines whether the new masking level will be louder than the equipment's upper intensity limit. If so, then at step 1209, the set speech masking levels module sets the new masking level to just below the upper limit of the equipment. If not, at step 1210, the set speech masking levels module determines whether the new masking level provides a sufficient level of masking noise, that is, a level equal to or greater then the previously calculated minimum masking level. If the new masking level provides an insufficient level of masking, then the set speech masking levels module reports the new masking level as resulting in a masking dilemma, and concludes its procedure. Otherwise, the set speech masking levels module determines at step 1212 whether the new masking level meets the masking turn-on criteria (typically, 0 dB) If it does not, then masking is turned off at step 1213, and the set speech masking levels module thereafter concludes its procedure. Otherwise, the set speech masking levels module simply concludes its procedure (i.e., without turning masking off).
The speech discrimination module concludes it procedure when either a sufficient percentage of correct responses has been received (e.g., 85 percent), or a large enough sample has been obtained to give an accurate assessment. In some embodiments, the percentage of correct responses is evaluated on a word by word basis, with a predetermined minimum of, for example, 10 correct words. Thus, if the patient responds correctly for the first  10 words, there is no need to continue testing, and the speech discrimination module may conclude its procedure by issuing a score of 100 percent speech discrimination accuracy. Similarly, if after 50 words, the patient has only chosen 20 of the correct pictures, then again there is probably no need to continue testing. In the latter case, the speech discrimination module issues a score reflecting the appropriate speech discrimination accuracy percentage (e.g., 60 percent discrimination loss). If, on the other hand, after 15 words the patient has only given 12 correct answers, then the speech discrimination module continues with testing until the termination conditions have been met.
generating a speech discrimination accuracy score based on the responses from the patient if the termination condition have been.
2. The method according to claim 1, wherein the step of determining a masking level includes determining if there is a masking dilemma.
3. The method according to claim 1, wherein the step of determining an optimal intensity level includes calculating a best performance point on a performance intensity curve.
4. The method according to claim 1, wherein the word-picture groups are randomly selected.
5. The method according to claim 1, wherein the termination conditions include a predetermined percentage of correct responses based on a minimum number of correct responses.
6. The method according to claim 1, wherein the termination conditions include a predetermined number of total responses.
7. The method according to claim 1, wherein the termination conditions are checked on a word-picture group by word-picture group basis.
8. The method according to claim 1, wherein the same picture group is used for each word.
9. The method according to claim 1, wherein no two words may have the same picture groups.
10. The method according to claim 1, further comprising correcting the speech discrimination accuracy score for guessing.
generate a speech discrimination accuracy score based on the responses from the patient if the termination condition have been.
12. The system according to claim 11, wherein the automated hearing test further causes the computer to determine if there is a masking dilemma.
13. The system according to claim 11, wherein the automated hearing test causes the computer to determine the optimal intensity level by calculating a best performance point on a performance intensity curve.
14. The system according to claim 11, wherein the automated hearing test causes the computer to select the word-picture groups randomly.
15. The system according to claim 11, wherein the automated hearing test causes the computer to check the termination conditions by checking for a predetermined percentage of correct responses based on a minimum number of correct responses.
16. The system according to claim 11, wherein the automated hearing test causes the computer to check the termination conditions by checking for a predetermined number of total responses.
17. The system according to claim 11, wherein the automated hearing test causes the computer to check the termination conditions a word-picture group by word-picture group basis.
18. The system according to claim 11, wherein the automated hearing test causes the computer to use the same picture group for each word.
19. The system according to claim 11, wherein no two words may have the same picture groups.
20. The system according to claim 11, wherein the automated hearing test further causes the computer to correct the speech discrimination accuracy score for guessing.