To complete my previous answer, I mentionned the use of notification to inform viewers when an action is required from them or something happen in the extension
I made a quick gif of a suggestion of how it could be integrated with this RFC, using the same design

The idea is to have all notification from all extension at the same place. Only one can be displayed at the same time.
A notification would stay visible for a few seconds.
The notification would be sent from a method :
twitch.ext.actions.sendNotification(content:string)
The streamer will have the possibility to mark the extension as “waiting for an action” when an action is required from the viewer, or something happened and the viewer should check it.
It would be possible using this method :
twitch.ext.actions.setActionRequired()
This methods will not return anything, like the “showBitsBalance” .
This would make an indication appear next to the extension logo to tell the viewer he can do something on this extension. For example the purple dot. Once the viewer click on the extension logo, the dot disapear.
If the extension is already open the dot doesn’t appears.
With this, we could notify viewers without breaking the UI/UX.
This system could also be later extended to other Twitch notifications like subgift, drops, etc