Hello, tinnitus could be due to many reasons.
1. Ear wax, if it is too close to ear drum.
2. Middle ear infections.
(formation of new bony tissue around middle ear bones).
4. Inner ear causes - due to heavy noise, some drugs like Aspirin, Diuretics etc.,
Few causes of pulsatile tinnitus
1. ASOM - acute suppurative otitis media
(purulent middle ear infection),
2. Arterio Venous Fistula (connection between an artery & a vein),
3. Acoustic Neuroma
(tumour of auditory nerve),
4. High blood pressure
In your case, perforation of the ear drum due to physical trauma was the cause of tinnitus. Middle ear infection following ear drum perforation resulted in muffled hearing.Your hearing improved as the infection was responding to antibiotics.
Exposure to sudden high pitched noise precipitated the tinnitus again. Pulsatile tinnitus indicates that the middle ear infection has not responded to the treatment but has progressed to acute suppurative otitis media (ASOM).