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sie isst = she eats / she is eating
sie (lower case) essen = they eat / they are eating
Sie (upper case) essen = you (formal) eat / you (formal) are eating
At the start of a sentence and in spoken language, the last two are identical. You need to look at the context to decide which one it is.
They don't sound the same. "ihr" sounds similar to English "ear" and "er" sounds similar to English "air" (imagine a British/RP accent).