Bring a large pot of salted water to a rolling boil over high heat. Add the orecchiette pasta and cook for 9-11 minutes, stirring occasionally until al dente. Reserve about a cup of pasta water for later use and drain the pasta.

In a large skillet, heat 1 tablespoon of olive oil over medium-high heat. Crumble in the Italian sausage and cook for 6-8 minutes, stirring frequently, until browned and cooked through.

In the same skillet, add the minced garlic to the sausage drippings and sauté for about 1 minute. Pour in the heavy cream, stirring continuously, and bring it to a gentle simmer. Let the sauce thicken slightly for 3-4 minutes.

Stir the grated Parmesan cheese into the thickened cream sauce along with salt and pepper to taste. Return the browned sausage to the skillet, then add the cooked orecchiette. Toss until well-coated, adding some reserved pasta water if necessary.

Garnish with freshly chopped parsley or basil and serve hot with extra Parmesan cheese on top.