Bring a large pot of salted water to a rolling boil over high heat. Add the orecchiette pasta and cook according to package instructions until al dente, about 10-12 minutes. Reserve 1 cup of pasta water, drain the rest, and set pasta aside.

In a large skillet, heat 2 tablespoons of olive oil over medium heat. Add the Italian sausage, pressing apart with a wooden spoon. Cook for about 5-7 minutes until browned and cooked through.

Stir in the minced garlic and let it sizzle for 1 minute until fragrant. Add the halved cherry tomatoes and cook for 3-4 minutes until softened.

Add the drained orecchiette pasta to the skillet with the sausage and tomatoes. Toss gently and gradually pour in the reserved pasta water until the desired sauce consistency is reached.

Turn off the heat and mix in the chopped fresh parsley, seasoning with salt and pepper. If desired, sprinkle with Parmesan cheese before serving.