If tmj is cause of major ear pain (worse when weather changes), ent says ear is normal, what is course of action? custom mouth guard? massage therapy?

See orofacial pain: Temporo-mandibular disorder is the second most frequent cause of orofacial pain after dental pain. Earache is a common symptom due to the close location to TMJ. Proper diagnosis is the key to the successful treatment. See an orofacial pain practitioner for a consultation and management.

It dspends: you should consult with a Tmj specialist or a Prosthodontist, you need proper diagnosis first. Finding where is the pain is coming from is the most important step. Occlusal guard, physical therapy, medications, diet...Are all options, in general you may need a combination of different treatments as it is hard to pin point the origin of the problem.

See your dentist: Have your dentist evaluate or refer you to an oral surgeon that can better assess the area and come up with a treatment modality that just does not mask the symptoms. Once the proper diagnosis is attained, a nightguard may be the correct therapy, a series of visits with an physical therapist, or other treatments may be indicated based upon clinical and radiographic interpretation.

TMJ Doc: Complex problem. See a TMJ expert. Any dentist can be a TMJ expert with the proper training and experience. Most commonly, oral surgeons, prosthodontists, and orofacial pain specialists. Ask your MD, your dentist and your dental society for referrals.