The kotsuzumi is used in Noh, the flute and percussion ensemble of Nagauta, the background music of Kabuki and a variety of folk entertainments. It is an altered version of the kakko used in Gagaku and at the end of the Heian period was used by the female court dancers called shirabyoshi. It then was used in Sarugaku together with the taiko and then became a standard part of the Noh ensemble in the Muromachi period. The standard Noh ensemble includes kotsuzumi, okawa, shimedaiko and the Noh kan.

The body of the instrument is made of cherry and is 25 to 27 cm. long. The exterior diameter at the thin center portion is from 9 to 10.5 cm. The cup shaped parts have an external diameter of 10 cm. and an interior diameter of 8 cm. The central core is lacquered and many instruments are very valuable as art objects. The skins are horse skin and are 20 cm. in diameter. The external edge is black and there are six holes. The two skins are tied to the body with a long linen cord called the "tate shirabe," which is 4.5 m. long and has a tassel on one end of the cord. Then this tate shirabe is wrapped around the middle with another cord called the "yoko shirabe," which is 4 m. in length and has tassels on both ends.

In Noh the player sits on a stool, in Nagauta the player sits in the seiza formal kneeling style. The performer grasps the shirabe cords with the left hand and then rests the instrument against his right shoulder. Then, the skins are struck with the right hand. The sound of the instrument can be changed by adjusting the tension of the cords. There are four different sounds, which are called "po," "pu," "ta" and "chi."