In Ethiopian and Eritrean Orthodox worship, the tsenatsil is a working liturgical instrument rather than a museum survival treated as a curiosity. It is shaken rhythmically by deacons and by the cantors known as debtera during the chanted and hymned portions of the service, particularly within the distinctive Ethiopian liturgical music tradition attributed to the sixth century saint Yared, and it typically appears alongside the kebero, a large drum, and prayer staffs used both for rhythm and, during long services, as something worshippers lean on. Its role is percussive and structural, marking the beat of the chant much as a timeline bell does in other traditions, rather than melodic.
The tsenatsil's continued central place in Ethiopian and Eritrean Orthodox liturgical music, alongside its startlingly long documented pedigree stretching back to ancient Egyptian temple practice, makes it one of the clearest examples in devotional instrument history of an object outliving, by millennia, the specific belief system that first gave it a religious purpose. Ethiopian church communities outside Ethiopia and Eritrea, including diaspora congregations in North America and Europe, have kept the tsenatsil in regular use as well, treating it as one of the clearest audible markers of continuity with home practice.