A simple, broadly applicable, standardized dysphagia severity scale would be useful to standardize dysphagia evaluations, to monitor recovery and efficacy of treatment and to study the consequences of dysphagia. We developed a global Dysphagia Severity Scale (DSS) from videofluorographic swallowing studies which included subjective clinical ratings of functional swallowing. We rated laryngeal penetration/aspiration (P/A) and pharyngeal retention (PR), and then assessed methods for scoring severity of P/A and PR and for combining them in a global scale. Each method was tested by correlation with overall clinical severity ratings. The highest correlations were found by: 1) scoring P/A based on which foods were aspirated (no aspiration or penetration; penetration only; thin liquid aspiration; thick liquid, pudding, or chewed solid food aspiration; 2) scoring PR based on how much food was retained (none; minimal; moderate; severe); and 3) combining P/A and PR by taking the higher of the two scores as the final DSS rating. The final global DSS score and the clinical severity rating correlated well (r = 0.71). This proposed scale shows promise for rating global dysphagia severity.