。
She listened to his words modestly, with downcast eyes.
Literal
She [topic-は] modestly downcast-eyes [becoming-て] his words [to-に] ear [object-を] tilted.
An evocative, slightly literary sentence. つつましやか is a な-adjective for 'modest, demure, reserved,' with つつましい as its more common kana counterpart. 伏し目になる ('lower one's gaze, become downcast-eyed') is a fixed phrase combining 伏し目 ('downcast eyes,' from 伏す 'to lower') with なる ('become'). The te-form 伏し目になって links the manner ('with eyes lowered') to the main action. 耳を傾ける ('lean an ear, listen attentively') is a vivid idiom — the literal image of physically tilting the ear toward the speaker conveys focused, respectful attention. The whole sentence paints a picture of traditional feminine reserve and attentive listening — vocabulary and posture both signaling quiet deference.