Begin by bringing a large pot of salted water to a rolling boil. Add the orecchiette pasta and cook until al dente, about 9 to 11 minutes. Once cooked, drain the pasta and reserve a cup of the starchy pasta water. Set the pasta aside.

In a large skillet, heat a drizzle of olive oil over medium heat. Crumble the Italian sausage into the pan, cooking it until it’s browned and thoroughly cooked, about 6 to 8 minutes. Transfer the sausage to a plate, leaving the drippings in the skillet.

Lower the heat slightly, then add minced garlic to the skillet, stirring for about 1 minute until it's fragrant. Be careful not to let it burn.

Pour in the heavy cream, stirring gently to combine with the garlic. Simmer for 3 to 4 minutes until the sauce thickens slightly.

Stir in the grated Parmesan cheese, allowing it to melt into the mixture. Season with salt and pepper to taste.

Return the browned sausage to the skillet, followed by the drained orecchiette pasta. Toss everything together thoroughly, adding reserved pasta water for desired consistency.

Sprinkle chopped fresh parsley or basil over the top before serving. Serve warm and savor every bite!