Bring a large pot of salted water to a boil and cook orecchiette according to package instructions.

In a large skillet, heat olive oil over medium-high heat. Add the sausage, breaking it into small pieces, and cook until browned.

Add garlic and chili flakes to the skillet and sauté for 1-2 minutes.

Drain the pasta, reserving 1/2 cup of pasta water, and add it to the skillet. Stir well to combine.

Stir in Parmesan cheese and parsley, adding reserved pasta water as needed for a creamy texture. Season with salt and pepper to taste.

Serve warm, garnished with extra parsley and Parmesan