Rescue teams battled overnight to reach the Rigopiano hotel, with the first of them arriving on skis. Snow dislodged by the avalanche had blocked the roads in.
One person has been pulled dead from the snow. Two have been found alive but most others appear to be still buried.
One official said there were “many dead” in the hotel.
Central Italy was hit by a succession of four earthquakes on January 18 and further tremors were reported overnight.
The earthquakes have compounded problems resulting from recent storms, which have brought down power lines and cut off villages.
Rescue operations are under way in other parts of the region as well.
The roof on the four-star spa hotel, close to the Gran Sasso mountain in the Abruzzo region, partly collapsed on January 18. Rescuers said at least 20 tourists and seven staff were inside at the time.
Crews had been calling out to survivors but there was no response.
Local residents in Farindola alerted emergency services.
The first victim, a man, was pulled out at about 09:30AM local time on January 19, Corriere della Sera reported.
Antonio Crocetta, the head of a mountain rescue team, was quoted as saying: “There are many deaths.”
There were children among the guests, and media reports say children are among the dead.
According to Italian media, some guests at the hotel had been able to send text messages after they were trapped.
A snowstorm and blocked routes made access to the hotel difficult. Vehicles struggled to get through the snow, and some rescuers eventually resorted to skis.
Italian media said the first rescuers only reached the hotel on skis at 04:00AM on January 19.
Video footage showed them shoveling through a wall of snow.
Two people were found alive outside the damaged building, which was surrounded by fallen trees. They were taken to hospital, one suffering from hypothermia.
The civil protection agency said it was now trying to get rescue vehicles to the hotel. There are reports that there is an ambulance a few miles away, which cannot yet reach the building.
The January 18 quakes came after the regions of Abruzzo, Marche and Lazio were hit by days of heavy snow.
One person in the area died and another was reported missing.
The same region was hit by a strong earthquake in August last year, when 298 people died.
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