The tsuzumi is the only Japanese drum that is struck with the hands; all other drums are played with sticks called "bachi". The tsuzumi is played while being suspended over the shoulder by its cords. A single drum head is struck with the tips of the fingers of one hand to produce a distinct "pon" sound, while the other hand holds the drum by its cords, squeezing or releasing them to change the pitch of the drum. Depending on how the player tightens or releases the cords of the tsuzumi, and how hard or soft he/she strikes the head with his hands, the tsuzumi can produce a range of sounds.
The tsuzumi plays roles in both Noh and Kabuki theater music, but it is also used in , or Japanese folk music. It is often played with its bigger counterpart, the (lit. Large tsuzumi AKA: ). Thus the tsuzumi is also referred to as the , or "small tsuzumi."