Objectives: There is need for a dysphagia severity scale that is simple, broadly applicable, and standardized for clinical and research purposes. Previous systems for rating dysphagia severity generally addressed sub-groups of patients and had limited utility. Methods: We developed the Dysphagia Severity Scale (DSS) for rating oral and pharyngeal dysphagia by analysis of videofluorographic swallowing studies (VFSS's) previously performed on 151 patients with various diagnoses. Patients swallowed thin liquid, thick liquid, puree, mechanical soft and solid foods mixed with barium. The VFSS database includes a subjective clinical severity rating by speech-language pathologist. Since the most important clinical characteristics of swallowing are airway protection and swallow efficiency, we rated each swallow for laryngeal penetration or aspiration (PA rating) and pharyngeal retention after swallowing (PR rating). We assessed methods for rating severity of PA and PR and for combining the two scores. Each method was tested by comparison with clinical severity ratings (using Spearman's coefficients). Results: The best correlations were found by: 1) rating PA severity based on which foods were aspirated (none; penetration only, thin liquid aspiration only, thick liquid or chewed solid food aspiration); 2) rating PR severity based on how much was retained with the food that resulted in the most retention (none, minimal, moderate, severe); and 3) combining PA and PR scores by taking the higher of the two scores (rather than their sum) as the final DSS rating. The correlation of the final DSS score with the clinical severity rating was .71 (P<.0001). There were only six cases where the DSS and clinical rating differed by more than one level. Conclusions: The Dysphagia Severity Scale is a new tool that uses an empirical rating of dysphagia severity and provides a standard for communication between clinicians. This scale can be utilized in research on treatment and rehabilitation outcomes.

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